HIV in pregnancy

Question 1

Screening

Answer 1

All pregnant women should be screened with ELISA and confirmed with Western Blot if positive after pre-test counselling
- New diagnoses require notification and contact tracing
-Perform VL and CD4 count
- FBE, UEC, LFT

Question 2

Management

Answer 2

• Pre-pregnancy:
  1. Education
• Risk of miscarriage, IUGR, preterm labour
• Vertical transmission
  2. Optimise disease
  
  • (Antiretroviral therapy) ART
    3. Prevent complications in pregnancy
• Commence high dose folate (5mg)
• Pneumococcal, influenza, Hepatitis B vaccinations
• Advise to quit smoking and drugs (reduced vertical transmission)
• Screen for STIs (chlamydia/gonorrhoea) and opportunistic infections (CMV/toxo/HSV)
• Antenatal
  o Multidisciplinary care: ID, obstetrics, neonatology, anaesthetics, SW
  o Education
• Risk of transmission depends on maternal viral load, mode of delivery and breastfeeding status
• Undetectable viral load, appropriate delivery, no
  breastfeeding, neonatal post-exposure prophylaxis: risk of transmission<2%
• Untreated mother with vaginal birth and no PEP: 20%
• Untreated mother with vaginal birth, no PEP and
  breastfeeding: 40%
  o Assess disease status
• HIV viral load and CD4 count
• HIV resistance
  § FBE, UEC, LFTs monthly