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    5 Hiv Aids in Pregnancy

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    BethelAberaHaydamo
    The document discusses prevention of mother-to-child transmission (PMTCT) of HIV/AIDS. It describes WHO's 4-prong approach to PMTCT, which includes preventing HIV infection in women of reproductive age, preventing unintended pregnancies, preventing mother-to-child transmission during pregnancy and delivery, and linking mothers and babies to long-term care and support. It also details Ethiopia's Option B+ strategy of providing lifelong antiretroviral treatment to all HIV-positive pregnant and breastfeeding women.

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    5 Hiv Aids in Pregnancy

    Uploaded by

    BethelAberaHaydamo
    31 views26 pages
    The document discusses prevention of mother-to-child transmission (PMTCT) of HIV/AIDS. It describes WHO's 4-prong approach to PMTCT, which includes preventing HIV infection in women of reproductive age, preventing unintended pregnancies, preventing mother-to-child transmission during pregnancy and delivery, and linking mothers and babies to long-term care and support. It also details Ethiopia's Option B+ strategy of providing lifelong antiretroviral treatment to all HIV-positive pregnant and breastfeeding women.

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    Original Title

    5 HIV AIDS IN PREGNANCY

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    The document discusses prevention of mother-to-child transmission (PMTCT) of HIV/AIDS. It describes WHO's 4-prong approach to PMTCT, which includes preventing HIV infection in women of reproductive age, preventing unintended pregnancies, preventing mother-to-child transmission during pregnancy and delivery, and linking mothers and babies to long-term care and support. It also details Ethiopia's Option B+ strategy of providing lifelong antiretroviral treatment to all HIV-positive pregnant and breastfeeding women.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    31 views26 pages

    5 Hiv Aids in Pregnancy

    Uploaded by

    BethelAberaHaydamo
    The document discusses prevention of mother-to-child transmission (PMTCT) of HIV/AIDS. It describes WHO's 4-prong approach to PMTCT, which includes preventing HIV infection in women of reproductive age, preventing unintended pregnancies, preventing mother-to-child transmission during pregnancy and delivery, and linking mothers and babies to long-term care and support. It also details Ethiopia's Option B+ strategy of providing lifelong antiretroviral treatment to all HIV-positive pregnant and breastfeeding women.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 26

    HIV AIDS IN

    PREGNANCY
    By Mengistu Lopiso , (MD ,GP)

    06/06/2022 1
    • Learning objectives:
    Describe the four prongs of PMTCT
    List components of PMTCT
    Describe option B+
    List the benefits of Option B+

    06/06/2022 2
    Gynecological Issues
    • Conditions causing inflammation or infection increase the
    likelihood a woman will acquire or transmit HIV.
    • Bacteral vaginosis
    • Cervicitis
    • Herpes ulcers
    • Genital warts
    • Condyloma.
    • Recurrent candidiasis
    • Prevalent in 25 – 30% of women with HIV
    • Risk increases 20 fold with CD4 <100.

    06/06/2022 3
    HIV and Pregnancy
    • Pregnancy does not accelerate the progression of HIV disease to AIDS.
    • Cd4 count may decrease up to 50 cell/mm3 but return to its pre pregnancy
    state.
    • Patients with AIDS are more likely to suffer from pregnancy related
    complications.

    06/06/2022 4
    06/06/2022 5
    WHO’s 4-prong approach to PMTCT
    1. Primary prevention of HIV infection
    2. Prevention of unintended pregnancy
    3. Prevention of mother to child transmission
    4. Linkage to care & support

    06/06/2022 6
    PRONG 1: Preventing HIV infection among
    women of reproductive age
    • 50% reduction in the number of women 15–49 years old acquiring HIV
    infection by 2015.
    • Primary prevention during pregnancy.
    • Education about safer sex with use of condoms.
    • Early treatment of STIs.
    • Safer sex during pregnancy and lactation.
    • PICT
    • Ensuring comprehensive, correct knowledge about how to prevent HIV
    transmission.

    06/06/2022 7
    Prong 2: Preventing unintended pregnancies
    among women living with HIV
    • By providing family planning services
    • Decreasing the level of unmet need

    06/06/2022 8
    Prong 3: PMTCT

    • Providing ART for the mother


    • Safe labor and delivery
    • Providing ARV for the neonate
    • Exclusive breast feeding up to 6 months

    06/06/2022 9
    Effect of HIV on pregnancy
    • Spontaneous abortion
    • IUGR
    • Preterm delivery
    • Low birth weight
    • Still birth
    • Perinatal mortality
    • New born mortality
    • Decreased fertility

    06/06/2022 10
    Timing of mother to child transmission

    During pregnancy
    (5-10%)

    During labor and delivery (10-20%)

    During breastfeeding
    (5-10%)

    06/06/2022 11
    Factors that increase MTCT
    Viral
    Viral load (the higher the viral load, the greater the risk of HIV transmission)
    Viral genotype and phenotype
    Viral resistance
    Maternal
    Maternal immunological status
    Maternal nutritional status
    New infection with HIV during pregnancy
    Maternal clinical status (including co-infection with an STI)
    Behavioral factors
    Antiretroviral treatment

    06/06/2022 12
    Obstetrical
    Prolonged rupture of membrane (longer than 4 hours)
    Mode of delivery
    Intrapartum hemorrhage
    Obstetrical procedures
    Invasive fetal monitoring
    Chorioamnionitis
    Fetal
    Prematurity
    Genetic
    Multiple pregnancy
    06/06/2022 13
    Infant
    Breastfeeding
    Gastrointestinal tract factors
    Immature immune system

    06/06/2022 14
    Option of ARV

    06/06/2022 15
    •Option B+

    06/06/2022 16
    What is option B+
    “Test and treat” strategy in which triple ARVs are started as soon as
    HIV is detected in a pregnant woman irrespective of CD4 count and
    gestational age
    • Treatment (ART) intended to be given for life
    • Specific ART regimen that requires just once a day dosing (either
    with one or two tablets), which will result in convenience for the
    patient and good drug adherence

    06/06/2022 17
    What are the Benefits of Option B+
    • Requires just one/two pills taken once daily
    • No need for CD4 test to initiate ART
    • Makes breast feeding safer
    • Avoids the need for extended infant ARV prophylaxis (Option A)
    • Mothers start treatment early, so quality of life and survival are better
    • Maintains continuity of care: ANC to post-weaning so improves infant
    testing as well as post-partum uptake of FP services.
    • Minimize HIV transmission among discordant partnership
    • Ongoing treatment of mother will protect future pregnancies from moment
    of conception.
    06/06/2022 18
    06/06/2022 19
    06/06/2022 20
    EFV IN PREGNACY
    • Better long term viral suppression
    • Less adverse effect
    • Less risk of resistance

    06/06/2022 21
    Initiating ART at ANC for HIV positive pregnant/ lactating women

    • ART requires 3 different ARVs that act differently in order to


    avoid development of drug resistant HIV

    • Use standard ARV drugs that are recommended for pregnant


    women for Option B+.

    • The ART regimen is easy to prescribe and easy to take since it is


    available as a once a day single pill

    06/06/2022 22
    Ethiopia’s 1st Line ART Regimen for HIV
    positive pregnant & lactating women
    1. Women diagnosed at ANC, labor, or post-partum should started
    TDF/3TC/EFV as soon as diagnosed.
    2. Women started on TDF/3TC/EFV prior to pregnancy can transfer their ART
    care to the PMTCT service provider integrated into MNCH care.
    3. Women who get pregnant while on an ART regimen other than
    TDF/3TC/EFV should continue the same regimen
    4. If woman on a non-TDF/3TC/EFV regimen wishes to have ART managed at
    PMTCT site, her ART Clinic provider must determine it is safe to switch
    regimens to TDF/3TC/EFV and agree to do so

    06/06/2022 23
    Detailed option B+: Recommendations

    1.During pregnancy:

    o TDF/3TC/EFV if for the first time

    o Continue same ART regimen if already initiated (unless ART provider

    agrees to switch to TDF/3TC/EFV)

    o If on AZT prophylaxis; Shift to TDF/3TC/EVF

    06/06/2022 24
    2. During labor and Delivery:

    o If on ART continue same regimen of ART

    o For women presenting for the first time initiate TDF/3TC/EFV

    o If on AZT prophylaxis; Shift to TDF/3TC/EVF

    06/06/2022 25
    3. Lactating or post partum.

    o Continue ART if started

    o Initiate TDF/3TC/EVF if on no treatment

    4. Infant regimen: NVP for six weeks post partum

    06/06/2022 26

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