HIV In Pregnancy

Question 1

Why is recognising and addressing HIV in pregnancy important?

Answer 1

There is a risk of infecting the child

Question 2

What is the most common cause of HIV infection in young children?

Answer 2

Mother to child transmission (MTCT)

Question 3

What percentage of MTCT HIV cases occur transplacentally?

Answer 3

1.5-2%

Question 4

How do the majority of MTCT cases of HIV occur?

Answer 4

• Maternofetal transmission during parturition

- Post-natal breast feeding

Question 5

When can women be screened for HIV?

Answer 5

At booking visit

Question 6

What infections are recommended to be tested for alongside HIV at booking?

Answer 6

• Syphilis
• Hepatitis B
• Rubella

Question 7

What should you do if a pregnant woman declines HIV testing?

Answer 7

• Document it

- Carefully explore reasons why

Question 8

When should screening for HIV be offered again after the booking visit?

Answer 8

28 weeks

Question 9

Does negative HIV test at booking rule out neonatal infection?

Answer 9

No

Question 10

Why does a negative booking HIV test not rule out neonatal infection?

Answer 10

Maternal infection and seroconversion can occur at any time in pregnancy and lactation

Question 11

What can increase the risk of MTCT of HIV in pregnancy?

Answer 11

• Higher levels of maternal viraemia
• HIV core antigens
• Lower maternal CD4 count
• Primary HIV infection during pregnancy
• Chorioamnionitis
• Co-existing other STD
• Invasive intrapartum procedures
• Rupture of membranes
• Vaginal delivery
• Preterm Birth
• Advanced maternal age

Question 12

What invasive intrapartum procedures can increase the risk of MTCT of HIV?

Answer 12

• Fetal scalp electrodes
• Forceps
• Ventouse

Question 13

When can rupture of membranes particularly increase the risk of MTCT of HIV?

Answer 13

If delivery is more than 4 hours after rupture

Question 14

What can decrease the risk of MTCT of HIV in pregnancy?

Answer 14

• Higher levels of neutralising HIV antibody
• Elective C-section
• Zidovudine (ZDV)
• Less invasive monitoring and intrapartum procedures

Question 15

How can diagnosis of HIV in the mother affect the risk of MTCT?

Answer 15

Earlier diagnosis can reduce the risk of transmission

Question 16

What interventions can used in the antenatal period to reduce MTCT of HIV?

Answer 16

• Anti-retroviral therapy
• Elective c-section
• Avoidance of breast feeding after delivery

Question 17

What are the advantages of anti-retroviral therapy in pregnancy for HIV?

Answer 17

• Helps prevent MTCT

- Prevents maternal disease progression

Question 18

How many anti-retroviral drugs are used at a time in HIV in pregnancy?

Answer 18

A combination of 3+

Question 19

By when should a decision about mode of delivery be made in a woman with HIV?

Answer 19

By 36 weeks gestation

Question 20

When can a vaginal delivery be planned in a woman with HIV?

Answer 20

When they are taking ART and has a plasma viral load of < 50 copies/ml

Question 21

How should women with HIV who opt for vaginal delivery be managed in labour?

Answer 21

• Keep membranes intact as long as possible

- Avoid fetal scalp electrodes and fetal blood sampling

Question 22

Which women with HIV should receive pre-term C-section at 38-39 weeks?

Answer 22

• Those on ART with plasma viral load of > 50copies/ml

- Women on ZDV monotherapy instead of ART

Question 23

How low can the risk of MTCT of HIV be reduced to if all steps are taken?

Answer 23

<1%

Question 24

What should the baby of a mother with HIV receive after birth?

Answer 24

• Anti-retrovirals within 4 hours until 4-6 weeks

- HIV testing in first 2 days, on discharge at 6 weeks and 12 weeks

Question 25

If initial HIV tests in the baby are negative what does this mean?

Answer 25

As long as the mother is not breastfeeding the baby does not have HIV

Question 26

When should a confirmation test for HIV be performed in a baby?

Answer 26

18 months

Question 27

Why should breast feeding be avoided in a mother with HIV?

Answer 27

It increases MTCT by ~15%