Transcript HIV and Pregnancy

HIV and Pregnancy
Dr. Deepa M Patil
MS(OBG)
Introduction:
The human immunodeficiency virus (HIV)
causes an incurable infection that leads
ultimately to a terminal disease called
Acquired immunodeficiency
syndrome(AIDS).
 Women- 25-30% and 90% between 15-35
yrs.
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Virology:
Five known human retroviruses.
 HIV 1 and HIV 2 – RNA retroviruses.
 Virus– attaches to T lymphocytes—CD 4
cells – gradual depletion of CD4 cells
 Primary infection-3-6 wks—acute
syndrome(1wk-3mth)—immune response
to HIV(1-2wks)
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Individuals at high risk for infection:
Prostitutes.
 IV drug abusers.
 Women whose partners are:
known HIV positive.
IV drug abusers.
 Women whose partners have had:
homosexual experiances.
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Mode of transmission:
i)Sexual contact.
 ii)Transplacental.
 iii)Exposure to infected blood or tissue
fluids.
 iv)Through breast milk.
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Effects:
Abortions.
 Prematurity.
 IUGR.
 Perinatal mortality.
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Maternal infection:
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Initial infection – asymtomatic.
Most pregnant women- asymtomatic carrier
stage.
Symptoms and signs: fever, night sweats, weight
loss, headache, sore throat, maculopapulary
rash.
Candidiasis,CMV,herpes,histoplasma,cryptococc
us,pneumocystitis carinii or Kaposi’s sarcoma.
Diagnosis:
Enzyme immunoassay(EIA)-screening
test.
 Serologic.
 Viral culture.
 PCR.
 Confirmation-Western blot
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Perinatal Transmission:
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Vertical transmission – 14- 25 %.
HIV 2- 1-4%.
HIV 1- 14-35%.
Transplacental transfusion as early as 8-14 wks
, 40-80%- during labour.
More in preterm labour and PROM.
Risk is directly proportional to the viral load and
inversely to maternal immune status.
Breastfeeding-14%.
Antepartum management of the
HIV infected patient:
Evaluation for other sexually transmitted
diseases.
 Serial ultrasound to follow fetal growth.
 Weakly NST after 32 wks.
 Measurement of CD4 count every
trimester.
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If CD4 > 500, reg obstetrical care.
 If CD4< 500 start therapy with Zidovudine
100mg five times daily.
 If CD4 < 200, start prophylaxis for
pneumocystitis carinii.
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Antiretroviral drugs:
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A)Neucleoside analogs:
Zidovudine.
Zalcitabine.
Lamivudine.
Stavudine
B)Protease inhibitors:
Indinavir.
Saquinavir.
Ritonavir.
 C)Nonnucleoside analogs:
Nevirapine.
Delavirdine.
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Triple chemotheraphy(CDC-1998) Two
from group A and one from either group B
or Group C.
Intrapartum Care:
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Precautions:
Protective eyeglasses, impermeable gowns and
double gloves.
Handle blood, amniotic fluid, and other
secretions and body fluids as if they were
infected.
Proper handling of needles and scalpels.
Nasopharyngeal and oropharyngeal secretions
removed by mechanical suction.
Intrapartum ZDV 2mg/kg IV over one hour
followed by 1mg/kg IV until delivery.
 Newborn treatment ZDV syrup 2mg/kg
every 6 hours for the first 6 weeks of life.
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Post Exposure Prophylaxis
Triple therapy for four weeks.
 ZDV 200mg tid + Lamivudin 150mg bid +
Indinavir 800mg tid.
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Postpartum Care
Mother instructed to avoid breastfeeding.
 Medical and paediatric followup for mother
and baby extremely important.
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Contraception
Barrier methods recommended.
 OC Pills and injectables avoided.
 Disease predominently prevented by
health education and practice of safe sex.
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Counselling
Pre-pregnancy and early pregnancy
counselling.
 Uptodate knowledge provided to make an
imformed choice.
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