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Obstetrics > HIV > Flashcards

HIV Flashcards

1
Q

What are the three classes of ARVs?

A

Nucleoside reverse transcriptase inhibitors (TDF, AZT, 3TC, FTC)
Non-nucleoside reverse transcriptase inhibitors (NVP, EFV)
Protease inhibitors (Aluvia, Kaletra)

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2
Q

What is first line ARVs?

A

Single tablet- EFV, TDF, 3TC

Trade names- odimune, atripla, atroiza

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3
Q

How often is viral load monitored?

A

Every 4/12

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4
Q

At what point is viral load concerning?

A

> 400

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5
Q

When can you not give AZT?

A

Anaemic patients, Hb

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6
Q

When can you not give EFV?

A

History of severe psychiatric illness

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7
Q

When can you not give TDF?

A

Severe/ chronic kidney disease

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8
Q

How do you manage a raised VL?

A

Check adherence. Re-check in 1/12. Move to SLR

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9
Q

What 5 parameters are integrated in PMTCT?

A

Antenatal care. Postnatal care. Child health. Reproductive health. TB screening.

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10
Q

What is done if TB screening is positive in an HIV positive mother?

A

Give INH prophylaxis

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11
Q

Why is a CD4 count done if option B is followed?

A 
Informs decision to - 
Provide prophylaxis (bactrim) if CLAT serum screen positive
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12
Q

How do you treat an HIV positive mother on HAART who comes in in labour with a high viral load?

A

Additional 3 hourly AZT

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13
Q

How do you treat an unbooked HIV+ mother in labour?

A

Truvada at start of labour.
Stat dose NVP
AZT 3 hourly in labour
(Option A)

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14
Q

What is Option A antenatally?

A

Treatment dependent on CD4 count (cut off 350)

>350- PMTCT AZT/NVP . Aim to protect baby. AZT from 14/40 plus labour protocol

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15
Q

What were the problems with Option A?

A

Doesn’t priorities maternal health.
Increase risk of transmission compared to HAART.
Increased postnatal transmission during BF.
Mixed feeding more likely.
NVP discontinued when supply from delivery runs out.

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16
Q

What are the aims of Option B regarding the population?

A

Halt the epidemic to save the new generation

17
Q

What are the aims for the infant of Option B?

A

Prevent vertical transmission by completely suppressing viral load
Aims to reduce infant mortality

18
Q

What are the aims for the mother in Option B?

A

Keep mother well so she can care for infant

Reduce maternal mortality

19
Q

What is Option B?

A

All pregnant women started on HAART irrespective of CD4.
CD4 and creatinine tested but no delay in rx.
Start rx on the day of booking (if concerned about C/I, then give AZT prophylaxis and refer to specialist)
Stop HAART 1/52 after BF stopped if mother well

20
Q

Under what circumstances is HAART continued after breastfeeding stopped?

A

Maternal CD4

21
Q

At what CD4 count is bactrim initiated?

A
22
Q

What are the problems with Option B?

A

Does not priorities maternal health.

23
Q

In Option B, why is stopping HAART a problem?

A 
Rx interruptions increases morbidity and mortality
Wrong message (can stop ART if well) 
All women will need to start HAART eventually
24
Q

Is there an increased risk of resistance with Option B because of stopping HAART?

A

No. Not is stopped correctly with cover of the NVP tail

25
Q

What is Option B+?

A

Much like option B but woman continues HAART for life instead of stopping after BF
Prioritizes maternal and infant health

26
Q

What are the problems with B+?

A

Expensive (but in LT these women will all need HAART anyway)

? Adherence problem

27
Q

What are the benefits of Option B+?

A

Prioritizes maternal and infant health
Will decrease transmission to HIV neg men
One clear message that ARVs are for life

28
Q

What is the drug group composition for lifelong ARV regimens?.

A

NRTI + NRTI + NNRTI

29
Q

What is the second line ARV composition?

A

NRTI + NRTI + PI

30
Q

What are the dangers associated with NVP?

A

Hypersensitivity is common –> rash, SJS, TENS; liver toxicity
Very high mortality
More common at CD4>250
Pregnancy protocol is

31
Q

Why is retesting so important in pregnancy?

A

If the mother seroconverts during pregnancy, labour or BF, the viral load is at its highest and the risk of transmission to the infant is higher than any other time

32
Q

When would you test a patient’s VL if recently started on ARVs (

A

Do at month 4 unless:
Patient likely to deliver within 1/12 of starting ART- do first VL at month 4 (will be high because no chance to suppress it yet if done any time before then)
If patient likely to deliver between 1-4/12 on ART then do 1st VL at 36/40

33
Q

How long do you provide infant PEP?

A

Until the mother is virologically suppressed

34
Q

What do you do if a VL is > 400 on first reading?

A

If 28/40, add Aluvia. For baby, consider birth PCR and adding AZT to NVP

35
Q

What do you do if the VL is >400 on second reading?

A

Switch to second line (change ALL drugs)

For baby, birth PCR and consider adding AZT to NVP

36
Q

What are other PMTCT strategies employed antenatally?

A

Avoid amniocentesis unless suppressed
Avoid ECV
Present early is SROM (>4 hrs has increased transmission risk)

37
Q

What other PMTCT strategies can be employed during labour?

A

Avoid scalp clips and scalp blood testing

No vacuum delivery

38
Q

What are the national guidelines regarding infant feeding?

A

All women continue FDC until 1/52 after BF stopped.
NVP syrup to baby for 6/52
Start NVP as soon after birth as possible, latest 72 hours

39
Q

When is HIV tested in pregnancy?

A 
At booking
Retest at 32/40
Retest in labour
Retest at 6/52 postpartum 
Retest 3/12 thereafter while breastfeeding

Obstetrics (18 decks)

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