HIV

Question 1

Define HIV in pregnancy.

Answer 1

Virus attacking T-lymphocytes.

Question 2

Explain the aetiology of HIV in pregnancy.

Answer 2

HIV present in vaginal fluid, semen, blood and breast milk. Transmitted by sexual contact, blood or vertical (mother to child).

Question 3

What are the risk factors for HIV in pregnancy?

Answer 3

Increased risk in vertical transmission if viral load high, CD4 count low.

PROM

Breastfeeding

Question 4

Summarise the epidemiology of HIV in pregnancy.

Answer 4

Increasingly common due to increased life espectancy of HIV+ patients.

Question 5

What are the symptoms of HIV in pregnancy?

Answer 5

Asymptomatic until AIDS (8-10y)

?Febrile seroconversion

Question 6

What are the signs of HIV in pregnancy?

Answer 6

No clinical features in HIV.

May present with infections, rarely with AIDS defining illness (KAP sarc, Pneumocystis pneumonia, oesophageal candidiasis)

Question 7

What investigations are performed for HIV in pregnancy?

Answer 7

Blood: Routine HIV screen and blood count, viral load.

Monitor drug toxicity: FBC, UE, LFT, lactate and blood glucose.

Question 8

What is the management for HIV in pregnancy?

Answer 8

Antenatal: Good control, HAART if CD4>350. Suppress viral to aim of <50 copies/mL.

Intrapartum: If viral load detectable or non compliant, advise C-section. IV zidovudine infusion from 4h prior to C-section.

Viral load undetectable: Consider vaginal delivery, avoid FBS/FSE or rupture or membranes for >4h.

Neonatal: Antiretrovirals for 4-6wk, PCR test at birth, 3wk, 6wk, 6mo, HIV ab test at 18m.

Question 9

What are the complications of HIV in pregnancy? What is the prognosis of HIV in pregnancy?

Answer 9

Side effect of HAARTI: Obstetric cholestasis, liver issues, lactic acidosis, glucose intolerance/GDM.

Transmisson rate can be reduced from 28% to 2% medically.