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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. Virology:.

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HIV and Pregnancy

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  1. HIV and Pregnancy Dr. Deepa M Patil MS(OBG)

  2. 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.

  3. 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)

  4. 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.

  5. Mode of transmission: • i)Sexual contact. • ii)Transplacental. • iii)Exposure to infected blood or tissue fluids. • iv)Through breast milk.

  6. Effects: • Abortions. • Prematurity. • IUGR. • Perinatal mortality.

  7. Maternal infection: • 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,cryptococcus,pneumocystitis carinii or Kaposi’s sarcoma.

  8. Diagnosis: • Enzyme immunoassay(EIA)-screening test. • Serologic. • Viral culture. • PCR. • Confirmation-Western blot

  9. Perinatal Transmission: • 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%.

  10. 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.

  11. 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.

  12. Antiretroviral drugs: • A)Neucleoside analogs: Zidovudine. Zalcitabine. Lamivudine. Stavudine

  13. B)Protease inhibitors: Indinavir. Saquinavir. Ritonavir. • C)Nonnucleoside analogs: Nevirapine. Delavirdine.

  14. Triple chemotheraphy(CDC-1998) Two from group A and one from either group B or Group C.

  15. Intrapartum Care: • 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.

  16. 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.

  17. Post Exposure Prophylaxis • Triple therapy for four weeks. • ZDV 200mg tid + Lamivudin 150mg bid + Indinavir 800mg tid.

  18. Postpartum Care • Mother instructed to avoid breastfeeding. • Medical and paediatric followup for mother and baby extremely important.

  19. Contraception • Barrier methods recommended. • OC Pills and injectables avoided. • Disease predominently prevented by health education and practice of safe sex.

  20. Counselling • Pre-pregnancy and early pregnancy counselling. • Uptodate knowledge provided to make an imformed choice.

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