HIV in pregnancy

Question 1

What is HIV in pregnancy (aetiology, RF)

Answer 1

HIV is present in vaginal fluid, semen, blood, BREAST milk - transmission via sex, BB, vertical
(less transmit via vagina than bum)

RF- vertical risk higher if viral load higher, CD4 down, prolonged rupture of membrane (>4h), breast feeding

Question 2

Sx and Ix of HIV in pregnancy

Answer 2

Sx- of mother
Asymptomatic - 1-4 w for seroconversion
General- fever, rash, lethargy, oral ulcers, lymphadenopathy, sore throat
AIDS defining- PCP, kaposis, MAC, oesophageal candidiasos

Ix-
HIV testing in antenatal booking - viral load, CD4
Baseling -FBC, UE, LFT, lactate, CBG

! neonates will test +ve for antibodies because passive transfer -need PCR

Question 3

Mx of HIV in pregnancy

Answer 3

Monitor- 2x CD4 (baseline and delivery)
8x viral load -measured every 2-4weeks, 36w and after delivery
keep viral load, obs factor and breastfeeding to minimum

Mother Mx-
ART- matneral -continual
Delivery - if viral load undetectable - vaginal
If viral load >50- ELCS at 38w,
OR if zidovudine monotherapy
(give zidovudine if detectable viral load before birth)
AVOID breastfeeding

Mx of infant -
Cord clamped as soon as possible and baby bathed after birth (immediate)
Zidovudine monotherapy for 2-4w (low/medium risk), 4w PEP (3x ART-2 NRTI, 1INI) combination
No breast feeding
all immunisation including BCG
PCR HIV at 6 and 12w