HIV in pregnancy

Question 1

HIV pregnancy effects

Answer 1

No increased progression in asymptomatic women
High risk of deterioration if advanced in the short term
Opportunistic infections may be less investigated eg sx of SOB

Question 2

Effect of HIV on pregnancy

Answer 2

Transmission (15-45% without therapy, <1% with it)
Miscarriage
PTB
IUGR

Question 3

Management with HIV

Answer 3

MDT
Reduce risk factors - contraception, contact trace, screen for other infections, dentist
cART - all people, safe in pregnancy (generally: mitochondrial toxicity, maternal lactic acidosis with DDI, protease inhibitors increase GDM, PTB and PET
Screen monthly CD4 and VL, LFTS, lactate, OGTT
VB: <50copies/mL
VB with zidovudine 50-400 therapy or CS
CS >400copies/mL
Abx prophylaxis if AIDs/previous infections
Avoid invasive procedures
Avoid BF
Infant review, PCR, PEP or zidovudine monotherapy

Question 4

Listeriosis
- Ddx
- Investigations
- Risks
- Management

Question 5

Malaria
- Ddx
- Investigations
- Risks
- Management