HIV treatment Flashcards
HIV treatment
AZT + Kaletra (protease inhibitor) + Limivudine (NNRTI)
Drugs to avoid
o Efavirenz (which is also in Atripla) • Neural tube defects o Nevirapine • Hepatotoxicity o Zalcitavine • Teratogenic in animals o Delavirdine • Teratogenic
Delivery
Viral Load 50 = elective C-section at 38 weeks
For Baby – AZT x 6 weeks + 1 dose of nevirapine at delivery
To reduce vertical transmission of HIV:
• Avoid drugs that may lead to interaction with antiretroviral drugs
• If elective caesarean delivery, should be at 38 weeks gestation.
• Minimize procedures that might increase transmission such as artificial rupture membranes, fetal scalp monitoring, fetal blood sampling, episiotomy.
• The interval between membrane ruptures and labor should be minimized if possible.
• Intrapartum ZDV (zidovudine) prophylaxis should be provided regardless of mode of delivery.
Anti-retroviral drugs should be continued as schedule during labor to maximal virologic effect.
Factors increase vertical transmission
• Viral load >500 copies/mL
• Mode of Delivery
o Vaginal + instrumentation > Vaginal > C-section (if don’t have ruptured membranes)
• Chorioamnionitis
• Rupture of membranes >4h
• Amniocentesis/Chorionic Villous Sampling
• Hep C co-infection
• AIDS defining illness
• Probably needs oral therapy for sure. If viral load down, then don’t need c-section
Cooper: do the c/s if most recent VL>1000c/Ml or if suspect unsuppressed. If the VL is known suppressed, then no need to to C/S. caveats - C/S not useful if the membranes have ruptured for 4 hours already - in that case, their is no benefit, only risk.
Another very important component of reducing MTCT is intra-partum, intravenous AZT. This is added in all cases, even if mom on fully-suppressive ART.
Also recommend against breast feeding, at least in developed world.
TORCHES
Toxoplasma, Rubella, CMV, Herpes, Syphillis, HIV
TB
Pyridoxine with isoniazid for pregnant and breastfeeding
