HIV in Pregnancy

Question 1

Transmission of HIV

Answer 1

• Contact with infected bodily fluids (sexual contact, needles or blood transfusion) or vertical trransmission (mother to baby)
• Transmission reduced by ART, condoms and oral PrEP
• Low risk of transmission in pregnancy if viral load <50 HIV RNA copies/ml

Question 2

Presentation

Answer 2

• Most have no symptoms in first few years
• May have systemic illness with fever, malaise and rash 6-12 weeks post infection
• As immune system deteriorates oral candidiasis and HSV may occur - more frequent as time goes on
• Opportunistic infections

Question 3

Delivery

Answer 3

• If viral load < 50 HIV RNA copies/ml at 36 weeks in adsence of obstetric contraindications planned vaginal delivery
• If viral load > 50 HIV RNA copies/ml at 36 weeks iplaned caesarean section

Question 4

Postnatal

Answer 4

• HIV PEP with zidovudine for the newborn comenced within 4 hours
• Breastfeeding avoided - 5-20% risk of transmission

Question 5

Neonatal testing

Answer 5

• Should be performed on the following occasions:
  
  • During first 48 hours and prior to hospital discharge
  • 2 weeks post cessation of infant prophylaxis (6 week)
  • 2 months post cessation of infant prophylaxis (12 weeks)
  • Testing for seroconversion at 18 months