HIV in pregnancy BHIVA Flashcards
What is the UK prevalence of HIV?
2/1000 women giving birth
3.5/1000 in London
Rate of diagnosed HIV mother to child transmission?
1.2%
<1% if at least 14 days ART
How much does breastfeeding increase risk of vertical transmission to baby?
50%, should not breastfeed
For women on effective cART before pregnancy are advised to continue except:
1 Protease inhibitor monotherpy
2. Regime’s low pharmacokinetics in pregnancy - darunavir/cobicistat and elvitegravir/cobicistat, raltegravir
If dolutegravir given, what potential SE and how to avoid?
Increased risk neural tube defect, start after 6 weeks, high dose folic acid
Recommend NRTI backbone in pregnancy?
Abacavir/lamivudine
or
Tenofovir/emtricitabine
Reccomened 3rd agent in pregnancy?
Efavirenz or Atazanavir
If not on cART when to commence based on HIV RNA copies?
<30,000: 2nd trimester
30-100,000: Start of 2nd trimester
>100,000 or CD count <200: 1st trimester
All women should be started by 24 weeks. Continue lifelong.
If women Dx late >28 weeks what should be offered?
3-4 drug regime including raltegravir or dolutegravir
Antenatal testing for women with HIV should include?
VL every 1-2 months and at 36 weeks
CD4 count
LFT
lactate
GTT
If invasive procedure required and HIV status not known?
Delay procedure until status know or VL has been suppressed
Management of untreated women presenting in labour
Stat diose nevirapine 200mg
Commence PO zidovudine 300mg, Lamivudine 150mgBD, raltegravir 400mg BD
IV zidovudine in Jaipur
What adjustment if preterm baby?
Double dose tenofovir
SROM and unknown HIV status?
Urgent HIV test, if reactive +ve - act upon immediately
How to decide on MOD with 36 week viral load
<50 consider VD
50-399 - consider ELCS (based on viral load, trend, length tome on Tx, adherence, obs factors, mat views)
>400 ELCS
If zidovudine monotherapy what MOD
ELCS, unless elite controller
Which women require zidovudine infusion in labour?
Viral load >1000 - labour, SROM, ELCS
Women where viral load unknown
Zidovudine mono therapy
Which women can have ECV?
Viral load <50
If CS being performed for reducing risk of vertical transmission, when should it be performed?
38-39 weeks
If obs reasons and viral load <50 can by after 39 weeks
If PROM and HIV +ve
Delivery within 24 hrs
Viral load <50 - augment
50-399, consider
+400 CS
Deliver if >34 weeks
<34 weeks PPROM - steroid, optimise HIV viral load, MDT discussion
When should infant PEP be commenced?
Within 4 hours of delivery
Which babies are considered very low risk, how much treatment do they need?
cART >10 weeks +
Viral load <50, 4 weeks apart
<50 at 36 weeks
2 weeks zidovudine
Which babies are considered low risk, how much treatment do they need?
If criteria above not met but viral load <50 at or after 36 weeks
Preterm most recent <50
4 weeks zidovudine
Which babies are considered high risk, how much treatment do they need?
Combination PEP if viral load unknown >50
If mother breast feeding
Give PEP as above
What pneumocystis pneumonia prophylaxis should be considered for neonate?
From 1 month if HIV PCR +ve or confirmed HIV, give co-trimoxazole
How often should infant molecular dx for HIV be carried out if formula feeding?
1st 48hrs
Before discharge
2 weeks - if high risk
6 weeks (or at least 2 weeks after prophylaxis)
12 weeks (8 weeks after stopping PEP)
If breast feeding how often should have infant HIV testing
1st 48 hours
Prior to discharge
2 weeks
Monthly during breastfeeding
4 and 8 weeks after stopping breast feeding
When should antibody testing occur?
If mother antibody status nor known - at first sample
22-24 months (or 8 week after stopping BF if this is later)
Postpartum care for mother with HIV
Review MDT 4-6 weeks
Assess mental health
Contraception
Cervical cytology at 3 month post delivery
Test partner/other children if new Dx
