HIV in pregnancy

Question 1

If a patient is unbooked, HIV positive and not on treament what is their management during labour?

Answer 1

Option A:
Stat TDF and emtricitabine
stat NVP
AZT 3 hrly throughout labour

Question 2

What is option B

Answer 2

All pregant women start HAART, irrespective of CD4 count and stop 1 week after all breastfeeding. Unless:

• mom CD4 less than 350 around delivery
• Stage 3 to 4
• Hep B sAg positive
• Unwell

Question 3

Why do a CD4 at booking?

Answer 3

Informs decision to:

provide prophylaxis- Bactrim for

Question 4

When do we do HIV testing

Answer 4

Booking visit
32 weeks
Admission to labour ward
6 weeks postpartum and three monlty for duration of breast feeding

Question 5

What is the best predictor of transmission antenatally, during labour and while breastfeeding?

Answer 5

Viral load

Question 6

What is the management of a woman has already been on ARVS for more than 4 monts

Answer 6

At booking: repeat viral load if not done in the last 3 months

Suppressed: Repeat in 6 months if patient is pregnant or breasfeeding. After cessation of breastfeeding check viral load yearly is all prior viral loads were undetectable.

Question 7

What is the management if viral load is more than 400?

Answer 7

FIRST READING:
under 28 wk: adherence support, repeat VL in 2 months
Over 28 wks: add aluvia. Consider birth PCR and adding AZT to NVP for baby

SECOND READING:

• switch to second line
• Baby: Birth PCR and AZT + NVP

Question 8

factors associated with increased transmission?

Answer 8

• High viral load/low CD4 counts 4 hours
• Invasive procedures such as amniocentesis/fetal blood sampling, instrumental delivery, fetal scalp electrodes and AROM
• Prematurity / low birth weight
• anamia
• Chorioamnionitis
• Mixed feeding
• Intercurrent STDs
• Hepatitis C co-infection
• Vaginal delivery

Question 9

Effect of HIV/AIDS on pregnancy

Answer 9

Some evidence for association between advanced HIV infection and increased risk of:

• Miscarriage
• Preterm delivery
• IUGR and low birth weight

Question 10

What is first line treament for HAART?

Answer 10

Efavirenz
tenofovir
Emtricitabine/ lamivudine

Question 11

What are the classes of antiretroviral drugs and mechanism of action of each?

Answer 11

• nucleoside reverse transcriptase inhibitors- nucleoside analogues which act as false substrates for reverse transcriptase.
• non-nucleoside reverse transcriptase inhibitors- directly inhibit reverse transcriptase (high level of resistance devlops rapidly)

Nucleotide reverse trascriptase inhibitors: exerts activity against HIV-1 reverse transcriptase.

Protease inhibitors- inhibits HIV protease enzyme resulting in non infectious viral particles

Question 12

What are the side effects of the ARVs

Answer 12

Nucleoside RTI (zidovudine, emtricit, lamivudine): Git disturbances, bone marrow suppression, flu like illness, lactic acidosis

NNRTI
Efv: rash, CNS Disturbances, git intolerance
Nvp: generalized hypersensitivity skin rash, hepatotoxicity

Nucleotide rti: tenofovir: nephrotoxic (not recommended if creat clearance

Question 13

How many days should an HIV Postibe mother take prophylactic antibiotics after Caesarian section?

Answer 13

3 days

Question 14

What does post partum care entail for an HIV positive mother?

Answer 14

1. Monitor for evidence of infectious complications
   2 promote and educate on feeding method of choice
2. Provide adequate contraception
3. Ensure follow up for mother
4. Ensure follow up for baby