HIV in pregnancy

Question 1

who to screen again in 3rd trimester?

Answer 1

• high risk groups
• high prevelance areas
• pts who declined conventional testing earlier in pregnancy

Question 2

is prenatal screening opt in or out?

Answer 2

• whenever possible: opt out. have to inform the patient it is being included.

Question 3

what to do with pt who presents in labor with unknown HIV status?

Answer 3

• order rapid HIV: negative test is negative. positive test does not mean necessarily positive (needs confirmatory western blot)
• additionally need viral load
• treat with ZDV
• CD if no SROM yet
• postpone breast feeding

Question 4

risk of HIV transmission:

• without ZDV
• with ZDV
• with ZDV and CD
• viral load < 1000 copies/ml and no CD

Answer 4

• without ZDV: 24%
• with ZDV: 8%
• with ZDV and CD: 2%
• viral load < 1000 copies/ml and no CD: < 1-2%

Question 5

PNC management

Answer 5

• ZDV 100 mg 5 x/day (or 200 mg TID) + another class of antivirals
• goal undetectable viral load

Question 6

Intrapartum management

Answer 6

Administer IV ZDV: 2 g/kg IV load over 1 hour, then 1 mg/kg/hr unti ldelivery
- if CD, then ZDV 3 hrs piror to delivery

Question 7

what agent do you need to be careful with methergine?

Answer 7

• protease inhibitors (can cause vasoconstriction)

Question 8

delivery planning

Answer 8

If VL > 1000 copies/ML -> CD prior to ROM
If VL < 1000 coplies/ml -> CD not indicated
If VL unknown -> CD

CD if: membranes intact, prior to onset of labor, VL > 1000

Question 9

what does non-occupational post-exposure ppx look like?

Answer 9

2-3 antiretrovirals (usually 2 reverse transcriptase inhibitors, 1 non-RT inhibitor) x 28 days

Question 10

occupational exposure post-exposure ppx?

Answer 10

combination ART x 6 months (low risk exposure: 2 nucleosides, high risk 2 + 1 protease inhibitor)