HIV in Pregnancy Flashcards
Which ART should be used in pregnancy for HIV1?
- If already on ART then this should be continued
- Ideal first regime
– TDS/ABC
with 3TC/FTC
And Efavirenz or r/atazanavir or dolutegravir if >6/40
Mum is taking dtg 400mg as part of her ART. What advice should she be given?
Take supplemental 5mg folic acid
Management of HIV positive untreated mum who presents at labour?
Stat - nevirapine 200mg
Oral AZT (zidovudine) and lamivudine (3TC)
Oral raltegravir
IV zidovudine for duration of labour
A woman requires an invasive diagnostic procedure during pregnancy and isn’t on HIV ART. What should be done?
If possible delay until good viral suppression has been achieved.
If not the patient should commence ART which includes raltegravir and be given a single dose of nevirapine 2-4 hours pre procedure.
Well controlled HIV in preg. <50 at 36/40. What delivery method?
Normal birth
HIV viral load >50 at 36 weeks. Whatdelivery method
Pre labour c section
HIV in pregnancy - Who should receive IV zidovudine?
Untreated mums in labour (i.e. unknown viral load)
Viral load >1000
“consider if 50-1000”
HIV in pregnancy
- HIV very low risk neonate. Definition and management?
Mum on ART for >10 weeks and 2 viral loads <50, at least 4 weeks apart, one of which is at or after 36 weeks
Management - 14 days AZT
HIV in pregnancy
- HIV low risk neonate. Definition and management?
Mum on ART for >10 weeks and maternal viral load is <50 after 36 weeks (but not on two occasions)
Or if baby born <34 weeks but most recent viral load <50
Management - 28 days AZT
HIV in pregnancy
- HIV high risk neonate. Definition and management?
Most recent viral load >50
Combination PEP advise
- Lamivudine (NRTI)
- Nevirapine (NNRTI)
- Zidovudine (NRTI)
Additional medication given to HIV pos mums who are not breastfeeding?
Cabergoline - suppresses lactation
Post natal testing of baby born to HIV pos mum who is not breastfeeding?
PCR at birth, 6 weeks, 12 weeks
Ag/ab test at 22 months (to demonstrate loss of maternal ab)
Post natal testing of baby born to HIV pos mum who is breastfeeding?
HIV PCR – at birth, 2 weeks, then monthly whist breastfeeding. Then 4 and 8 weeks after cessation of breastfeeding.
Ag/ab testing at 22 months or minimum of 8 weeks after stopping breast feeding, which ever is later
Risk of postnatal acquisition of HIV due to breast feeding in well controlled patient with HIV.
Risk of breast feeding in mum on cART is 0.3% at 6 months and 0.6% at 12 months
NB higher risk if extreme prematurity due to leaky gut.
HIV 2 PEP for high risk baby born to hiv pos mum?
zidovudine, lamivudine and raltegravir
