Pregnancy in HIV-positive individuals require special attention to prevent mother-to-child transmission of the Virus.

1. CURRENT TRENDS IN PREVENTION OF MOTHER TO
CHILD TRANSMISSION(PMTCT) OF HIV
BY
ODUWE UGOCHUKWU (BMLS, AMLSCN)
(HAEMATOLOGY AND BLOOD TRANSFUSION SCIENCE)
PRESENTED TO THE DEPARTMENT OF MEDICAL
LABORATORY SERVICES, UNIVERSITY OF BENIN
TEACHING HOSPITAL, BENIN CITY.
SUPERVISED BY: MRS. M. EBENGHO
AUGUST, 2021.

2. ABSTRACT
DEFINITION OF TERMS
INTRODUCTION
EPIDEMIOLOGY
RISK OF HIV IN PREGNANCY
MODERN PRACTICES IN HIV POSITIVE
PREGNANCY
CONCLUSION
RECOMMENDATION
REFERENCES
OUTLINE

3. ABSTRACT
• Globally over 430,000 new cases of HIV are reported in children
less than 15 years with over 90% occurring through mother to child
transmission. HIV in pregnancy may lead to some negative impact
on the pregnancy such as low birth weight, intrauterine growth
retardation, still birth, transmission of the virus to the unborn foetus
among others. Modern practice in preventing mother to child
transmission include targeted efforts in viral suppression of HIV
positive mothers. More advocacy on the need for proper antenatal
care especially in HIV positive pregnancy should be carried out.

4. DEFINITION OF TERMS
HIV- Human Immunodeficiency Virus
AIDS- Acquired Immunodeficiency Syndrome
PMTCT- Prevention of Mother to Child Transmission
MTCT- Mother to Child Transmission
ART- Antiretroviral Therapy
cART-Combination Antiretroviral Therapy
ARVs – Antiretroviral Drugs

5. Approximately 37.9
million people across
the globe were living
with HIV/AIDS in 2018,
and 1.7 million of
these were children
(<15 years old).
The primary aims of
managing HIV infection in
pregnancy are the
prevention of MTCT of the
virus, maintaining maternal
health, and offering a safe
and healthy environment for
delivery for mother and
child.
INTRODUCTION
(Yvonne et al., 2018)
(Medecines Sans Frontiers,
2018)

6. EPIDEMIOLOGY
Globally, about 430,000 children are newly infected with HIV
annually; over 90% are through mother-to-child transmission (MTCT).
The HIV seroprevalence among women attending antenatal clinic in
Edo State was 4.1%, compared to the national average of 3.0%, in
2014.
Without intervention, the risk of mother-to-child transmission ranges
from 20% to 45%. ( Ashipa et al., 2016)

7. RISK OF INFECTION IN PREGNANCY
• The second and third trimesters of pregnancy appeared to
be the periods of highest risk for HIV acquisition.
(Thomson et al., 2018)
• Pregnancy hormone-associated changes in the female
genital tract may create a favourable environment for HIV
acquisition in the female genital tract during pregnancy.
(Pelzer et al., 2017)

8. HIV induced
immunosuppression:
Herpes simplex, HPV,
candidiasis, bacterial
vaginosis, syphilis,
Trichomonas
vaginalis, Hepatitis B
and C.
(Magiorkinis et al., 2016)
IMPACT OF HIV ON PREGNANCY AND PREGNANCY OUTCOMES
HIV induced poor
birth outcomes:
spontaneous
miscarriages,
stillbirths,
intrauterine growth
restriction,
low birth weight,
and chorioamionitis.
HIV-related
opportunistic
infections :
tuberculosis,
pneumonia
seem to be
frequent
during
pregnancy.

9. MODERN PRACTICES IN HIV POSITIVE
PREGNANCY
PRE-CONCEPTION COUNSELLING
MONITORING OF PREGNANCY
ANTIRETROVIRAL THERAPY
(Jean et al., 2016)

10. FIG 1: HIV TREATMENT MONITORING ALGORITHM( WHO,2021)

11. ANTIRETROVIRAL TREATMENT IN PREGNANCY
• Dolutegravir is the common drug of choice in pregnancy.
There is, however, a global consensus that women who
conceive on effective cART should continue cART
throughout pregnancy and then lifelong.
• Triple antiretroviral drugs recommended which should be
maintained throughout the period of risk of MTCT (late
pregnancy, labour and breastfeeding) and continued for
life.
(WHO,2021)

12. MODE OF DELIVERY
Vaginal Delivery if viral load <50copies/ml
Planned C-section if any Obstetric complication
C- section if virally unsuppressed or viral load unknown
(Kind et al., 2015)

13. • Breastfeeding is particularly important to some
mothers, but it is essential for all to understand
that HIV can be transmitted through breast milk
in erstwhile uninfected babies.
• For women not on cART, the risk of infecting the
baby is affected by detectable HIV viral load.
BREASTFEEDING
(Bispo et al., 2017)

14. ART for baby
Antibiotics and proper monitoring
Infant PCR( DBS) at 6weeks and RTK after 18months
THE NEONATE
(WHO, 2021)

15. CONCLUSION
HIV in pregnancy is a condition that needs proper
medical care and management in order to prevent
the transmission of HIV to the unborn foetus.
International guidelines must be adhered to by
healthcare personnel in management of HIV in
pregnancy, this will lead to safer deliveries for the
mother and decline in vertical transmission of HIV.

16. RECOMMENDATIONS
• More advocacy on the need for proper
antenatal care should be carried especially in
low income countries with high prevalence of
Mother to child transmission.
• All primary health centres should be equipped
to offer PMTCT care to clients within their
locality.

17. SELECTED REFERENCES
• Ashipa, T., Ighedosa, S. U. (2016): Assessment of the services and materials available for the PMTCT programme in Benin
City, Edo State,Nigeria. Journal of Medicine and Biomedical Research. 15(2):34–46.
• Bispo. S., Chikhungu. L., Rollins. N., Siegfried, N., Newell, M.L.(2017). Postnatal HIV transmission in breastfed infants of HIV-
infected women on ART: a systematic review and meta-analysis. Journal of the International AIDS Society. 20(1): 46-57
• Brookfield, K., Duthely, L., Cotter, A.(2011). Rupture of membranes greater than four hours is not a risk factor for perinatal
HIV transmission in the era of combination antiretroviral therapy. American Journal of Obstetric and Gynaecology.
72(15):124-128
• Consolidated guidelines on the use of antiretroviral drugs for treatment and prevention of HIV infection
recommendation.(2021) World Health Orrganization. https://who.int/news/item/17-03-2021-who-publishes-new-clinical-
recommendations-on-hiv-prevention-infant-diagnosis-antiretroviral-therapy-initiation-and-monitoring. last accessed 11th,
August, 2021.
• Jean, J., Coll, A., Monda, M., Potter, J.N., Jones, D.(2016). Perspectives on safer conception practices and preconception
counseling among women living with HIV. Health Care for Women International. 37(10): 1096-1118.

18. • Kind, C., Rudin. C., Siegrist, C.A., Wyler, C.A., Biedermann, K., Lauper, U.(2015). Prevention of
vertical HIV transmission: additive protective effect of elective Cesarean section and zidovudine
prophylaxis. Swiss Neonatal HIV Study Group. AIDS. 12:205–210.
• Magiorkinis, G., Angelis, K., Mamais, I., Katzourakis, A., Hatzakis, A., Albert, J. (2016). The global
spread of HIV-1 subtype B epidemic. Infection, Genetics and Evolution. 46:169–179.
• Medecins Sans Frontiers (2018). UNAIDS report on global AIDS epidemic. https://msfacess.org/msf-
reacts-2012-unaids-global-report-0.com. Last accessed 12th August, 2021.
• Pelzer, E., Gomez-Arango, L.F,, Barrett, H.L., Nitert. M.D.(2017):Maternal health and the placental
microbiome. Placenta. 54:30–37.
• Thomson, K.A., Hughes, J., Baeten, J.M.(2018): Increased risk of female HIV-1 acquisition
throughout pregnancy and postpartum: a prospective per-coital act analysis among women with
HIV-1 infected partners. Journal of Infectious Diseases. 218:16–25.
• Yvonne, G., Shema, T., Alasdair, B., Sanjay, B., Emily, C. (2018). British HIV. Association guidelines for
the management of HIV in pregnancy and postpartum. HIV Medicine. 20(3):82-85.