HIV in Pregnancy: ID of intrapartum and perinatal HIV exposures Flashcards
Vertical rate of transmission f HIV in Canada?
<2%
When no interventions are undertaken during pregnancy, delivery or the neonatal period, perinatal HIV transmission rates can be as high as ____%.
25
Risk factors for higher transmission rates of HIV?
Pregnant women with:
- Late or no prenatal care
- Injection drug use
- Recent illness suggestive of HIV seroconversion
- Regular unprotected sex with a partner known to be living with HIV (or with significant risk for HIV infection)
- Diagnosis of sexually transmitted infections during pregnancy
- Emigration from an HIV-endemic area
- Recent incarceration
When does transmission typically occur?
Some in utero, but majority at time of delivery
Additional risk for infection?
If breastfed
When is risk of transmission especially high?
When mother has acute or early untreated infection
While the number of HIV-infected newborns has declined in NA since implementation of HIV testing in pregnancy, there is a related rise in _______.
The number of infants exposed to antiretroviral agents in utero
Long-term outcomes of concern after intrauterine exposure to antiretroviral agents?
-Neurodevelopmental and learning problems
Standard approach to diagnosing HIV infection during pregnancy in Canada?
Multistep serology testing
- First step: a screening test for HIV antibodies using an enzyme immunoassay
- If immunoassay reactive, the sample is re-tested using a more specific confirmatory test for HIV antibodies (e.g. Western blot)
What are the ways that transmission of HIV from mother to child can be reduced and virtually eliminated?
- HIV testing during pregnancy
- Appropriate perinatal antiretroviral therapy
- Reducing HIV exposure during delivery
- Avoiding breastfeeding
Recommendation re: HIV testing in pregnancy?
HIV testing in early pregnancy is recommended as the standard of care in Canada for all pregnant women
When is repeat testing throughout pregnancy recommended?
- For all women who are HIV-seronegative on initial testing, but who are known t be at high risk for HIV acquisition
- Repeat testing in the third trimester (ideally before 36 weeks) should also be considered for other HIV-seronegative women when their ongoing risk of acquiring HIV is unclear
Health care providers caring for pregnant women who are identified as being HIV-positive should__________________.
Consult with specialists with expertise in managing HIV in pregnancy for advice on counselling about prevention of transmission to the infant and to sexual partners, appropriate antiretroviral therapy, optimal follow-up durinig pregnancy, and intrapartum and postnattal prophylaxis.
Failing to ensure that the HIV status of a pregnant women is conveyed to the team who will be caring for her at delivery increases risk of ______ and may result in_____.
Neonatal HIV transmission, unnecessary exposure of the newborn to antiretrovirals.
Women who present in labour with undocumented HIV status should undergo _______.
Rapid HIV testing at the time of labour or delivery.
What to do if results of rapid HIV testing at time of labour or delivery are positive?
- Intrapartum and infant postnatal antiretroviral prophylaxis should be initiated immediately, pending results of the confirmatory HIV antibody test
- Consult urgently with a Peds ID specialist because preferred antiretroviral regimens are evolving
Women who have not been tested for HIV before or during labour should undergo ________. What if they are not available or refuse testing? What if they refuse permission to have infant tested?
- Rapid HIV antibody testing in the immediate postpartum period
- If unavailable or refuse, newborns must undergo rapid HIV antibody testing
- If refuse permission to have infant tested, child protection authorities may need to be notified
What to do if test results are positive for mother OR infant?
- Infant antiretroviral prophylaxis should be initiated immediately and no later than 72h post delivery
- Breastfeeding should be deferred until confirmatory HIV antibody test result is available and proves negative
What to do if rapid HIV antibody testing unavailable and there is concern that the mother is high risk for HIV infection?
Consider starting newborn antiretroviral prophylaxis pending test results
What to do when a mother or newborn tests positive for HIV antibody (i.e. exposure)?
- The infant should be tested immediately for infection by HIV DNA or RNA PCR within 48h of birth if possible
- If positive, prophylaxis should be stopped and antiretroviral treatment initiated in consult with Peds ID
What to do for HIV seronegative women in whom acute HIV infection is suspected during pregnancy, intrapartum or while breastfeeding?
A virologic test (e.g. HIV RNA PCR, or antigen test) should be perrformed as soon as possible because antibody tests may be negative early in HIV infection
Results of maternal and infant HIV testing should be __________.
Documented in the newborn’s medical record and communicated to the newborn’s primary care provider
What to do if HIV infection was initially diagnosed int he mother during or after delivery?
Arrangement should be made for her appropriate follow-up and ongoing care
What should HCPs monitor for in infants who have been exposed to HIV infection or antiretroviral agents?
- Short-term effects e.g. anemia, neutropenia
- Long-term outcomes e.g. general health, growth and neurodevelopment
______ is recommended for infants in foster care and for adoptees whose birth mother’s HIV infection status is not known.
HIV antibody testing
