HIV and pregnancy (Complete) Flashcards
What infections are routinely screened for in pregnant women during booking appointment?
HIV
Hepatitis B virus (HBV)
Syphillis
Appointments typically done at week 10
What investigation is used for initial screening of HIV in pregnant woman?
ELISA
Checks for presence of HIV antibodies
If ELISA findings are positive, what further investigations are required?
CD4 count: Measures disease progression
Viral load (PCR): Measure active infection
Hepatitis B and Hepatitis C screen: Co-infection likely with HIV
How are pregnant women with HIV managed during pregnancy?
Conservative:
CD4 count monitoring: At baseline and at delivery
Viral load: Every 2-4 weeks, at 36 weeks and after pregnancy
Medicine:
cART: Given as soon as diagnosis confirmed
How often is CD4 count monitored in HIV positive pregnant women?
At baseline and at delivery
How often is viral load monitored in HIV positive pregnant women?
Every 2-4 weeks
At 36 weeks
After delivery
How are pregnant women with HIV managed during labour?
Depends on the viral load at 36 weeks
Viral load < 50 at 36 weeks:
Vaginal delivery suitable if no co-infection with hepatitis C
Viral load > 50 OR co-infection with hepatitis C:
C-section is required (usually done at 38 weeks)
AND
Zidovudine: In any patient with detectable viral load (>50)
Vaginal delivery is suitable in which individuals with HIV?
If viral load <50 AND no hepatitis C co-infection
C-section delivery is required in which individuals with HIV?
Detectable viral load (>50)
Co-infection with hepatitis C
What medication is given during delivery in all HIV women with detectable viral load
Zidovudine
When the baby is delivered, what should be done as soon as possible to minimise risk of transmission?
Clamp clord as soon as possible
Bath baby immediately after birth
In normal circumstances, clamping is delayed for at least 60 seconds to reduce risk of anaemia
What is the post-natal management plan?
Medicine:
Low risk:
- PEP prophylaxis (Zidovudine) for 2-4 weeks
High risk:
- PEP prophylaxis (Zidovudine) for > 4 weeks
- cART for 4 weeks
Conservative:
HIV PCR testing at 6 and 12 weeks (2 and 8 weeks after stopping PEP)
What medication is given as post-exposure prophylaxis?
Zidovudine
PEP is given for how long in low-risk infants compared to high-risk?
Low-risk: 2-4 weeks
High risk: > 4 weeks
What is given after PEP for high-risk neonates?
cART
When is HIV PCR testing offered following management with PEP?
Offered at 2 and 8 weeks of stopping PEP
What advice should be given regarding breastfeeding?
Infant should be formula-fed and mother can be offered cabergoline to help reduce milk production.
If mother has low viral load then can breastfeed if they wish but requires monitoring and should be aware of risks
How does congenital HIV infection present?
Often assymptomatic with infants presenting with immunosuppresion later in life
What is the risk of HIV transmission from mother to infant in the UK?
1%
Very low due to effective management
