Hiv

Question 1

+ve

Answer 1

MDT approach (Obs phys, Obs, moth to child transmission counseling, paeds
HIV RNA viral load
HIV resistance testing
CD4+ve lymphocyte subsets
FBC, LFTs, U/Es, Cr
ARV therapy
STI screening (syphilis, hep b &C, chlamydia, gbs

Question 2

Risk of transmission with no maternal transmission counselling

Answer 2

20%
40% if breast feeding
If mum on HAART and breastfeeds risk is 1-5%

Question 3

Risk of transmission with counselling and what this entails

Answer 3

Maternal viral load undetectable
Right mode of delivery
Formula fed baby
Baby has PEP
Risk is 2%

Question 4

Management of HIV +ve women in labour

Answer 4

If viral load <50: can have bnb, no need for meds
If viral load 50-399: consider intrapartum zidovudine, consider c/s b/w 38-39
If viral load >400: c/s and intrapartum zidovudine
If not on haart and term: need nevirapine and raltegravir, as per above for high viral load
If not on haart and preterm; nevirapine, start haart, double dose tenofivir, and raltegravir; same as per above for high viral load

Question 5

HAART

Answer 5

Zidovudine + lamivudine OR
Tenofivir + emtricitabine OR abbacavir + lamivudine
Cannot use stavudine(d4t) and DDI in pregnancy

Question 6

Risk of transmission to the baby if good antenatal care to mother and baby?

Answer 6

<1%

Question 7

Care in labour

Answer 7

Avoid FSE, FBS and prolonged ROM

Question 8

Treatment of baby

Answer 8

Zidovudine to baby w/in 4 hours to be given for 2-4 weeks