Management of HIV in Pregnancy

Management of HIV in Pregnancy Kevin F. Deasy 103034879 Group 6

HIV Burden Prevalence in Ireland

7,800 individuals (6,300 9,700) 2,400 women (1,900 3000)

5 Mother to Child Transmission (MTCT) The probable countries of infection for

all cases were in subSaharan Africa. No MTCT cases were identified in

children born in Ireland in 2012.

97 new HIV+ women in 2012 22 were reported to be pregnant at time of

diagnosis 55% had a CD4 count

General Approach Multidisciplinary Reduced MTCT rate from 25-30%

to

Antenatal Screening Opt-out antenatal

HIV screening programme

The latest available data report uptake rates of >90% over the years 2002 to 2006

High risk patients should be offered repeat testing

Maternal HIV Care 1) Assessment of maternal health

Assess & manage at a specialist adult HIV service

Antiretroviral therapy for CD4 count of

Obstetric Care Antenatal Care In general, no need for

increased antenatal surveillance

HAART reduces risk of vertical transmission with invasive pre-natal testing

There may be an

increased risk of pre-eclampsia, impaired glucose tolerance

Increased risk of premature

labour Screen for UTI

Obstetric Care Intrapartum Care Vaginal delivery

Adequate duration & response to ARVT

Avoid: Foetal scalp electrodes Foetal blood sampling

Peripartum IV AZT

Regardless of antenatal ARVT and viral load.

Triple therapy in neonate > 12hours between rupture of

membranes and delivery Instrumental delivery

Obstetric Care Elective Caesarean Section Studies have shown not

> HAART

Higher morbidity

Indicated for monotherapy with AZT

Should be performed at

38wks to avoid membrane rupture

Infant Care Infant feeding

Breast feeding, 10-15% increased transmission risk Ireland = No

Infant ARVT

Commence within 4 hours of birth, continue for 4 weeks

Low risk Mono || High risk - HAART

Monitoring for toxicity AZT Anaemia, neutropenia FBC @ 1 day, 2,6,12 weeks Liver function tests

Testing for HIV

Avoid cord blood sampling PCR testing for HIV @ 1 day, 2,6,12 weeks HIV antibody @ 18 months

Vaccination & Prophylaxis

Defer BCG until after PCR HIV test results All routine primary immunisations PCP prophylaxis if HIV +ive, or high risk

Main Points MDT approach

Early opt-out screening, with repeat

screening for high risk patients

Manage high risk patients

HAART Triple therapy is standard Combivir (Zidovudine Lamivudine) 1 tablet Protease inhibitor (lopinavir/ritonavir,

saquinavir/ritonavir or atazanavir/ritonavir)

Caesarean section not absolutely indicated

Manage infant care based on risk status & exposures

No breast feeding

Thanks!

Sources RCPI Guidelines HSEHealth Protection Surveillance Centre

(HPSC) HIV in Ireland 2012 Report

UN, WHO & CDC epi data

Management of HIV in PregnancyHIV BurdenGeneral ApproachAntenatal ScreeningMaternal HIV CareObstetric CareObstetric CareObstetric CareInfant CareMain PointsThanks!Sources