HIV/AIDS

Mother to child transmission of HIV AIDS in Pregnancy
Mandy Osambi
Health Consultant
Kisongo clinic for women
Arusha Tanzania

HIV AND AIDS IN PREGNANCY.

Summary.

• Of pregnancy Introduction
• Mother to child Transmission of HIV (MTCT)
• Prevention of mother to child transmission of HIV
• Antenatal care of women with HIV and AIDS
• Care during labour and delivery
• Postnatal care of women with HIV and AIDS
• Follow up for HIV exposed child
• Use of prophylactic antiretroviral (ARU) drugs during pregnancy
• The adverse effect of HIV/AIDS on the outcome of pregnancy.
• The adverse effect in HIV/AIDS
• Introduction

Why is HIV/AIDS of special concern in pregnancy?

HIV/AIDS is a major medical problem complicating pregnancy in Tanzania
HIV/AIDS has major adverse effects with outcome of pregnancy
Pregnancy may adversely affect the course of AIDS in advanced stages

Prevalence

Prevalence of HIV in pregnancy in Tanzania varies from 4 -32 %.

Mother to child transmission of HIV (MTCT)

The risk of MTCT is estimated at 15-40 % in developing world.
MTCT (vertical transmission) is cause of over 90% of all HIV infected children aged below 15 years.
MTCT is estimated to be the cause of about 72.000 infected children's in Tanzania annually (year 2000 data).
In Tanzania MTCT is about 40% distributed as follows:
10% In Utero
20% During labour and delivery
10% Through breast feeding


Estimated risk of MTCT in the absence of intervations (including risks during pregnancy labour and delivery.

Timing and Transmission

During Pregnancy 5% -10%

During Labour and delivery 10% -15%

During Brest Feeding 5% -20%

Overall withought breast feeding 15% -25%

Overall with breast feeding to 6 month 20% -25%

Overall with breast feeding 18to24 month 30%-45%

Factors associated with increased MTCT of HIV, viral factors

A.
Viral load

High levels of Maternal
Subtypes of HIV virus: Subtypes is associated with higher MTCT than A, B, and D.

B.
Maternal factors

Primary HIV infection during pregnancy
Poor maternal nutrition
Presence of abruption or chorioamnionities
Maternal disease stage: Advanced stage – MTCT
Presence of other maternal infections in pregnancy and delivery STI, syphilis, vaginosis, etc
Factors associated with increased MTCT of HIV

C.
Fetal factors

Prematurely
Genetic susceptibility
Twin pregnancy

D.
Postnatal factors

Breast conditions (mastitis, abscess, and nipple cracks)
Pattern of infant feeding: - prolonged breast feeding
mixed feeding
Infant infection (e.g., oral thrush, gastritis)
Prevention of MTCT of HIV (PMTCT)

• Promotion of access to counseling and testing in FP, MCH clinics, antenatal words etc
• Promotion of male involvement in PMTCT
• General information, education, and communication in the general population
• Promote HIV education during pregnancy

Prevention of MTCT can be achieved through:

• FP in FP clinics and comprehensive ANC
• Provision of prophylactic ARV to HIV infected pregnant women
• Provision of comprehensive ANC
• Provision of appropriate obstetric car
• Modification of infant feeding practices
• Exclusive breast feeding or exclusive replacement feeding
• Avoid inteinvasive procedures during ANC, ECV, do C/S when feasible

Antenatal care of women with HIV/AIDS

• Give similar obstetric ANC to both HIV negative and positive.
• No need for increased ANC visits to those who are HIV positive of have AIDS unless there are complications
• Provide grated ANC/Medical care to HIV related conditions
• Provide social and psychological support
• Provide counseling to include: Potential modes of transmission esp. delivery method and infant feeding
• Encourage to involve partner
• Provide continued support
• Teach as HIV related programs e.. Wt loss, diarrhea
• Teach self care & nutrition

Care during labour and delivery

Follow outline

• Avoid repeated VE during labour
• Avoid prolonged rapture of membranes
• Avoid ARM if progress of labour is adequate
• Avoid unnecessary episiotomies
• Avoid suction of the newborn unless it is absolutely necessary
• Periods are likely to be intensified


Postnatal car of a woman with HIV/AIDS

Stress and anxiety of the postnatal period are likely to be intensified.

Elements to be addressed in postnatal care include
continued care at MCH/postpartum clinic and addressing HIV related emotional land clinical issues Provide adequate emotional support Elicit early sings and symptoms of physical and emotional stress and help accordingly gloves should be worn when examining the perineum C/S wound, cord care, changing baby diaper, etc.

• Mother should be encouraged to care for baby if conditions allow.
• Plan for ongoing care by Community Health worker prior to discharge
• Decision to inform other care givers of her HIV status should be left of the women herself
• Information on contraception should be offered before discharge.
• Postnatal care of HIV/AIDS patients (continue)
• Teach on early signs of HIV infection and encourage reporting to clinic
• Discuss with pt. feeding options and the additional risk of breast feeding
• Discuss option for replacement feeding
• Promote access to FP
• Plan with the woman for early regular follow up at the nearest care and treatment clinic (CTC).


Follow up for the HIV exposed child

Babies born in Health care facilities should receive MCH card with NVP (Nevirapine) prophylaxis dose must be indicated if given.
Routine follow up (monthly to one year, than three monthly to 5 years)
Do a full clinical reassessment at each follow up visit including growth and development assessment.
Counsel about feeding practices. Avoid giving both breast milk and formula milk (limited feeding) in the first 6 months of life.
Start Contrimoxazole prophylaxis from 6 weeks onwards
Perform an antibody test for HIV infection at 18 months, and if the child is breast feeding at 6 weeks after stopping breast feeding


Use of prophylactic antiretroviral (ARV) drugs during pregnancy

Use of ARV have been shown to reduce MTCT
All pregnant HIV positive women should be prescribed Nevirapine and advised to take it when labour starts.
Women who deliver at home should be advised to bring their babies for Nevirapine administration within 72 hours of delivery
A single dose of 200 mg orally is given to the mother at onset of labour combined with a single 2 mg/kg oral dose given to her infant within 72 hours after delivery
If a pregnant women is on ARV (first or second line the rapy) then the baby still needs to be given a single dose of NVP and the mother needs counseling on breastfeeding options; exclusive breast feeding or formula milk

Cotrimoxazole prophylaxis for the HIV exposed child

Weight Dosage

Below 10kgs 5mg/kgs syrup

Between 10kgs 1/2tab single strength

Above 15kgs 2tabs single strength