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CPS ID and Immunizations > Prevention of Vertical HIV Transmission > Flashcards

Prevention of Vertical HIV Transmission Flashcards

1
Q

What is the standard of care for prevention of vertical HIV transmission?

A
  • Routine prenatal HIV testing
  • For all women testing positive:
    • Antepartum combination antiretroviral therapy
    • Intrapartum IV zidovudine
    • 6 wks postnatal PO zidovudine for infant
    • Exclusive formula feeding
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2
Q

What is the vertical transmission rate of HIV in women prescribed cART > 4 wks prior to delivery?

A
  • 0.1%
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3
Q

Which women should undergo repeat HIV testing late in pregnancy?

A
  • IVDU
  • Commercial sex work
  • HIV negative women of a serodiscordant couple
  • Frequent unprotected intercourse with multiple partners
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4
Q

Who needs a pre-labour elective C/S?

A
  • HIV + women not on cART
  • Anticipated/documented to have viral load > 1000 copies/mL
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5
Q

Who does not need intrapartum IV zidovudine?

A
  • HIV infected women who received cART during pregnancy and had viral load < 400 copies/mL
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6
Q

What is the ID-SOGC recommendation about intrapartum IV zidovudine?

A
  • Recommend intrapartum IV zidovudine for all HIV infected women regardless of antepartum ART regimen, mode of delivery or viral load near delivery
  • BC data indicated 9% women with antenatally undetectable viral load found retrospectively to have detectable viral loads at delivery
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7
Q

What antiretroviral prophylaxis is required for an infant born to a mother who received antenatal cART with documented viral load < 40 copies/mL?

A
  • PO zidovudine for 6 weeks
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8
Q

What antiretroviral prophylaxis is required for an infant born to a mother who received cART with a viral load 40-999copies/mL?

A
  • PO Zidovudine for 6 weeks OR
  • PO Zidovudine for 6 weeks PLUS 3 doses of nevirapine during first week of life OR
  • cART
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9
Q

What antiretroviral prophylaxis is required for an infant born to a mother who received antenatal cART but whose viral load was > 1000 copies/mL?

A
  • Zidovudine for 6 weeks PLUS 3 doses of nevirapine during first week of life OR
  • cART
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10
Q

What antiretroviral prophylaxis is required for an infant born to a mother who did not receive antenatal cART?

A
  • Zidovudine for 6 weeks PLUS 3 doses nevirapine during first week of life OR
  • cART
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11
Q

When should antiretroviral therapy be started in babies born to HIV + mothers?

A
  • ASAP after birth, preferably within 6-12h after birth
  • Efficacy decreases with increasing time after birth and is likely completely lost when initiated beyond 72h of life
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12
Q

What medications compose cART?

A
  • Zidovudine + Lamivudine + Nevirapine
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13
Q

Why should lopinavir/ritonavir (Kaletra) not be used in infants in the immediate postnatal period?

A
  • There is potential for life-threatening toxicity
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14
Q

What are the reported toxicities of lopinavir/ritonavir?

A
  • Transient symptomatic adrenal insufficiency
  • Life threatening bradyarrythmias and cardiac dysfunction
  • Lactic acidosis
  • Acute renal failure
  • CNS depression
  • Respiratory depression
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15
Q

In what gestational age may lopinavir/ritonavir be used?

A
  • Postmenstrual age of 42 weeks and a post natal age of at least 14 days
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16
Q

How should babies born to HIV + mothers be fed?

A
  • Exclusive formula feeding
  • All provinces and territories should provide free formula to all infants of HIV infected mothers for the first 12 months of life
17
Q

What is the CPARG and ID-SOGC recommendation about pre-mastication of food by HIV + caregivers?

A
  • Advise against this practice as there is potential for HIV transmission
18
Q

What is the preferred assay for diagnosis of HIV infection in infants < 18 months of age?

A
  • HIV DNA and/or RNA PCR
19
Q

At what child age should transplacental maternal antibody be cleared from the circulation?

A
  • 25% clear by 12 months
  • all infants should be clear by 18-24 months
20
Q

At what time can you finalize HIV status of exposed infants?

A
  • Serological assay should be performed at 18-24 months
21
Q

What are the most common acute side effects observed with zidovudine?

A
  • Reversible anemia and neutropenia
22
Q

How should HIV exposed infants be followed up?

A
  • Long term follow up and physical examinations into adulthood is expected for HIV uninfected infants with ongoing psychosocial support

CPS ID and Immunizations (7 decks)

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