HIV in pregnancy

Question 1

percentage of vertical transmission in canada

Answer 1

less than 2%

Question 2

percentage of vertical transmission without treatment

Answer 2

as high as 25%

Question 3

risk factors for HIV infection in pregnant women

Answer 3

1. late or minimal prenatal care
2. IV drug use
3. recent illness suggestive of HIV seroconversion
4. regular unprotected sex with partner known to be HIV positive (or with significant risk factors for HIV infection)
5. STI during pregnancy
6. emigration from HIV endemic area
7. recent incarceration

Question 4

side effects of neonatal antiretroviral exposure

Answer 4

anemia, neutropenia

neurodevelopmental consequences

Question 5

when should pregnant women have a 3rd trimester HIV test

Answer 5

if they have ongoing risk of contracting HIV during pregnancy (i.e. unprotected sex with high risk partners, IV drug use)

Question 6

What if presents in labour with undocumented HIV status?

Answer 6

do rapid HIV test of mother at delivery
if mother refuses do it on the infant
if mother refuses both then call CAS
if it is positive on either start prophylaxis and order confirmatory antibody testing
if PCR is positive on infant change to HIV treatment
if rapid testing not available then consider starting prophylaxis in mother with risk factors of exposure while awaiting antibody testing results

Question 7

when does antiretroviral prophylaxis need to be started on infant post delivery

Answer 7

as soon as possible and no later than 72 hours