Peripartum management of HIV-positive patients

Question 1

Haematological effects of HIV

Answer 1

• Reduced CD4 count
• Anaemia
• Thrombocytopaenia
• Hypercoagulability

Question 2

Neurological effects of HIV

Answer 2

• Aseptic meningitis
• Seizures
• Stroke
• Cerebral oedema
• Raised intracranial pressures
• Polyneuropathies

Question 3

Cardiovascular effects of HIV

Answer 3

• Pericardial disease
• Cardiomyopathy
• Arrhythmias
• Pulm HTN
• Aneurysms
• VTE

Question 4

Respiratory effects of HIV

Answer 4

• URTI
• Sinusitis
• Pneumonia (PCP)
• Empyema
• Intrapulmonary cavitation

Question 5

Gastrointestinal effects of HIV

Answer 5

• Candida
• Herpes simplex
• Oesophageal ulceration
• Cholangiopathy
• Hep B & C

Question 6

Renal effects of HIV

Answer 6

• Glomerulonephropathies
• AKI assoc with diarrhoea and malabsorption

Question 7

Adverse effects of protease inhibitors

Answer 7

• Hyperlipidaemia
• Hyperglycaemia
• Hepatotoxicity
• P450 inhibition
• Exaggerated vasoconstrictive properties

Question 8

Adverse effects of non-nucleoside reverse transcriptase inhibitors

Answer 8

• Hepatotoxicity
• Severe skin rashes (Steven Johnson)
• P450 inducer
• Weight loss
• Fatigue

Question 9

Adverse effects of nucleoside reverse transcriptase inhibitors

Answer 9

• Hepatotoxicity
• GI disturbances
• Headache
• Insomnia
• Peripheral neuropathy

Question 10

Obstetric management in HIV +ve patients

Answer 10

• If viral load <1000 induced at 39/40 can have vaginal delivery
• If >1000 caeserean at 38/40
• All patients should continue antiretroviral therapy

Question 11

Neuraxial anaesthesia in HIV +ve peripartum management

Answer 11

• Generally safe
• Need to check platelet count
• If space-occupying lesion in CNS then avoid
• Peripheral neuropathies are common so documentation of pre-existing deficits is recommended
• Epidural blood patches are also safe