HIV in Pregnancy

DEFINITION
 Sexually transmitted disease are group of

communicable diseases that are transmitted by
sexual contact and caused by a wide range of
bacterial,viral,fungal agents.
HIV VIRUS
HIV (HUMAN IMMUNO DEFICIENCY
SYNDROME)
 HIV causes an incurable infection that leads ultimately to a
terminal called acquired immunodeficiency syndrome. (AIDS).
MODE OF TRANSMISSION:-
-Sexual contact
-Transplacental
-Exposure to infected blood
-Through breast milk
Effects:-
-Incidence of abortion, prematurity, IUGR
Acc. to NATIONAL FAMILY HEALTH
SERVICES(NFHS) prevalence of HIV in pregnant
lady>1% in 118 districts of India in general
population.
In U.S. rate of HIV +ve
pregnant women
is 1-2 per 1000 women.
In Asia infection rate is <0.5%
MODE OF TRANSMISSION
AND RISK FACTORS
Sexual contact -unprotected heterosexual
intercourse with infected partners.(75%),
High risk in women –
whose heterosexual
partner use iv drugs.
Multiple sex partners.
Women with STDs other than HIV .
Injecting Iv drugs(20%).
Blood transfusion.
Virus attaches to t lymphocytes cd4
cells
Virus produce multiple genome in

host cell
Host cell damage
Cd4 cells decreases in no.
Loss of human immune defense
Opportunistic infections
AIDS
CLINICAL PRESENTATION
Primary infection(3-6wks)
Fever, Malaise, headache, sore

Acute syndrome(1wk-3mnth)
throat, maculopapular rash
Immune response to hiv(1-

2wk)
•Multiple
infections(candiaisis, tb,
Clinical latency
pneumocytis etc)
•May be neoplasma-
About 10 yrs cervix carcinoma
•Lymphoma
•wt.loss
AIDS
•Lymphednopathy
CLINICAL PRESENTATION
 Initial presentation:-fever, malaise, headache, sorethroat, &
maculopapular rash.
 Asymptomatic carrier state:-Infected people have antibodies
& lymphadenopathy .
 AIDS Related complex:-Damaged immune system, oral
thrush, spleen enlargement, decreased no. of T-helper
lymphocytosis.
 AIDS:-It is end stage of HIV Infection.
- Persistant generalised lymphadenopathy,
oropharengeal candidiasis, rhinitis, dermatitis.
EFFECTS OF AIDS ON PREGNANCY
Infertility Still births

Repeated abortions Congenital
Prematurity abnormalities
IUGR Embropathies
INVESTIGATION
EIA(enzyme immunoassay) – screening for HIV

antibodies.
PCR(polymerase chain reaction)
Western blot test
IFA(Immunofluoresence assay)
Cd4 cell count -<200 cells/mm3 or develop one
of other condition
DIAGNOSIS OF HIV
Major sign- Wt loss>10% of body wt.

-Chronic diarrhoea
-Prolonged fever >1 month
Minor sign:-
Persistent cough >1 month,
generalized lymphadenopathy,
cervical cancer.
Lab. Diagnosis:- ELISA test

MTCT - MOTHER TO CHILD
TRANSMISSION
 An HIV+ve woman can transmit the virus to her
baby during pregnancy ,labour ,delivery and
breast feeding. MTCT chances 20-45% without
ARVT .
RISK FACTORS OF MTCT OF
HIV
Antepartum
factors intrapartum postpartum
• High maternal viral • Cervicovaghinal hiv •Breast feeding

load levels
• Low maternal cd4 • Mode of delivery
count • Prolonged rupture
• Progression to aids of memvbranes
• Vit a deficiency • Premature delivery
• Illicit drug use • Vaginal laceration
• Amniocentesis • Episiotomy
• Especially in 3rd • Invasive fetal
trimester unbooked monitoring
or late booking • Instrumental
• Lack of antenatal delivery
care
EFFECTS OF MTCT ON BABY
Negative impact of maternal HIV disease - poor
antenatal care.
Fetal exposure to ARVT- Tetrogenicity.
Needs expert pediatric care.
HIV infected baby appears normal at birth but
 Untreated baby will have serious illness/die in
first year.
 Before treatment- 50%die by age 9.
 Treated child – 95% survive at least 16 yrs.

PREVENTION OF TRANSMISSION OF
HIV TO LADY
Women should avoid all possible sources
of infection before & throughout pregnancy.
Sexual contact with someone who is infected.
Needles, razors or other
item possibly contaminated
with blood of infected person.
 Women should know about HIV status of her
person.
 Proper use of condoms helps
protection against HIV& other Stds.
MANAGEMENT
 Prenatal Care:-
a) Voluntary serological testing.
b) Seropositive cases –tests for STDs, toxoplasmosis.
& husband should be offer serological testing for
HIV.
c) Counselling
d) Antiretroviral therapy:-To be start any time between
14and 34 weeks &continue throughout the pregnancy.The
combination of drugs are:
-Nevirapine(200mg) PO
-Zidovudine 500-600mg TDS
-Zalcitabine 0.375-0.75mg TDS
CONTD..........
 INTRAPARTUM CARE:-
- Zidovudine is given IV infusion starting at onset of labour (vaginal delivery) or
4hours before caesarean section ,dose 2mg/kg/hr,mainatenace dose
1mg/kg/hr,untilcord clamping is given.
- Elective caesarean delivery should preferred first.
- Caps ,masks,gowns & double gloves should be worn. Protective eye wear
should be used.
POSTPARTUM CARE:-
- Breast feeding:
- Zidovydine syrup 2mg/kg is given to neonates
4 times daily for first 6 week of life.
MANAGEMENT OF HIV +VE PREGNANT
LADY
1. PLANNED PREGNANCY :
Counseling about the risk of transmission to the
neonate should be made and termination offered .
HIV +ve discouraged to have pregnancy
or otherwise couple can go for:
Effective contraception
(both are +ve),because
re-infecting can occur.
Artificial insemination(HIV+ve
women and –ve partner).
Sperm washing (HIV-ve women
and +ve partner).
2. PRENATAL CARE:
Voluntary serological testing

cd4 counts, viral load – for progression of
disease
Other tests :test for STDs, for CMV &
Toxoplasmas, Tb.
Husband should be offered serological testing.
ARV therapy
ANTIRETROVIRAL THERAPY(ARVT)
Anti HIV-1 drugs are grouped into

Neucleoside analogs (zidovudine, zalcitabine,
lamivudine).
Protease inhibitors(indinavir, ritonavir)
Nonnucleoside
analogs(nevirapine,delaviridine)
INTRAPARTUM POSTPARTUM
ANTEPARTUM
•ZDV 300mg •IV ZDV at • ZDV syrup at

bd/tid initiated loading dose of 2mg/kg 6hrly to
newborn begun at
at or after 14 2mg/kg first hr, 8-12hr for 6 wks(IV
wks of followed by 1mg ZDV at 2 mg/kg q6h
pregnancy(to /kg/hr till in those who could
prevent –ve delivery. not tolerate oral
effects on fetus) intake;ZDV at
1.5mg/kg IV or po
or ZDV 100mg 5 q12 in preterm
times daily p.o + infants<34wks for
the first 2 wks may
be considerd).
3. INTRAPARTUM :
Elective CS decreases risk of

MTCT by50% and ARVT decreases by 2%.
Cord should be clamped as early as possible.
Baby should be bathed.
Take maternal and cord sample.
Caps, mask, doubles should be worn.
Mechanical suctioning devices should be used
to remove secretions from neonates airway.
 Blunt tipped needle should be used.
 All universal aseptic
technique should be used

 Post exposure prophylaxis(PEP):
ZDV 200mg+;Lamivudine150mg+Indinavir800mg .
4. POSTPARTUM :
 Do not breastfeed.
THE SOCIAL AND PSYCHOLOGICAL
IMPACTS
 Encourage partner referral for HIV testing.
 Preparing the mother for dual challenge of
preventing transmission to the baby and taking
care of her own health.
 Enlisting support from the social
 services agencies.
 Supportive environment for the newborn.

MANAGEMENT TO PREVENT MTCT
Pregnant woman of Known HIV infected
unknown status women
Counseling
Antenatal care Medical care on family
planning
Universal HIV
pregnancy
testing
HIV PREGNANT WOMAN

• MULTIDISCIPLINARY CARE OBSTRETICS ,PAEDIATRICIAN,HIV
PHYSICIAN,SOCIAL WORKERSETC.
•INFOMED DECISION MAKING BY MOTHER PLAN DEVELOPED
FOR MTCT PREVENTION AND HIV DISEASE MANAGEMENT
•CLOSE FOLLOW UP
Rapid HIV
Recommend and
Consider
Rapid HIV educate against
elective CS
breast feeding
FULL IMPLEMENTATION OF ANTIRETROVIRAL REGIMEN:

ANTEPARTUM:ZDV+3TC+PI
INTRAPARTUM : IV ZDV
POSTPARTUM :(Dis)continuation in mother as Supervised
by HIV physician ;ZDVPO fort6 wk in neonate.
PRESENTATION AT LABOUR:
INTRAPARTUM :ZDV+3TC+single dose NVP ;continue
ZDV+3TC For 7 days Postpartum in mother.
POSTPARTUM :single dose NVP+ZDV for 6 wk in neonate.
PRESENTATION AFTER DELIVERY AND WITH IN 48HR:

POSTPARTUM :immediate single dose NVP+ZDV for 6 wk
in neonate.
Plus evaluation for maternal management plan.
THANKS

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DEFINITION

 Sexually transmitted disease are group of

Virus produce multiple genome in

Host cell damage

Cd4 cells decreases in no.

Loss of human immune defense

Fever, Malaise, headache, sore

Immune response to hiv(1-

Infertility Still births

EIA(enzyme immunoassay) – screening for HIV

Major sign- Wt loss>10% of body wt.

Lab. Diagnosis:- ELISA test

• High maternal viral • Cervicovaghinal hiv •Breast feeding

 Treated child – 95% survive at least 16 yrs.

Voluntary serological testing

Anti HIV-1 drugs are grouped into

•ZDV 300mg •IV ZDV at • ZDV syrup at

Elective CS decreases risk of

technique should be used

 Supportive environment for the newborn.

HIV PREGNANT WOMAN

FULL IMPLEMENTATION OF ANTIRETROVIRAL REGIMEN:

PRESENTATION AFTER DELIVERY AND WITH IN 48HR:

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