HIV in Pregnancy

Question 1

Name some factors which reduce vertical transmission (from 25-30% to 2%).

Answer 1

• Maternal antiretroviral therapy
• Mode of delivery (C-Section)
• Neonatal antiretroviral therapy
• Infant feeding (Bottle feeding)

Question 2

What does NICE recommend regarding screening?

Answer 2

HIV screening should be offered to all pregnant women.

Question 3

Describe current recommendations regarding antiretroviral therapy.

Answer 3

• All pregnant women should be offered antiretroviral therapy regardless of if they were taking it before.
• If women are not currently taking antiretroviral therapy the RCOG recommend that it is commenced between 28 and 32 weeks of gestation and should be continued intrapartum.
  • BHIVA recommend that antiretroviral therapy may be started at an earlier gestation depending upon the individual situation

Question 4

At what gestational age should the fetus be born and should the fetus be born using C-section or vaginally?

Answer 4

• 36 weeks
• Vaginal delivery is recommended if the viral load is less than 50 copies/ml at 36 weeks OTHERWISE C-section is recommended.
• A Zidovudine infusion should be started 4 hours before beginning the C-Section.

Question 5

How should neonates be fed?

Answer 5

Bottle fed to reduce vertical transmission rates,.

Question 6

What drugs should be given to the neonate as part of post-exposure prophylaxis.

Answer 6

• If maternal viral load is <50 copies/ml, then zidovudine monotherapy should be given to the mother.
• If maternal viral load is >50copies/ml, then Triple ART should be used.

Therapy should be continued for 4 to 6 weeks.