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ASID Guidelines Perinatal Infection > HIV > Flashcards

HIV Flashcards

1
Q

Antenatal testing for HIV

A
  • Recommended for all women
  • Screen with an enzyme immunoassay (EIA) test
  • Confirm with Western blot (WB)
  • Repeat testing in 3 weeks if recent exposure or re-exposure to HIV likely
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2
Q

Indeterminate Western blot

A
  • Further testing needed
  • Discuss with HIV reference laboratory
  • Discuss with physician specialising in HIV infection
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3
Q

Additional Tests if HIV positive

A
  1. HIV RNA viral load
  2. HIV resistance testing
  3. CD4+ve lymphocyte subsets
  4. FBC, LFT, EUC etc
  5. Other infectious disease (syphillis, chlamydia/gonorrhoea, GBS screening)
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4
Q

Four components of prevention of MTCT of HIV

A
  1. Maternal viral load undetectable on effective cART
  2. Appropriate MOD
  3. Formula fed baby
  4. Baby PEP
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5
Q

Risk of HIV vertical transmission with optimal care

A

<1%

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6
Q

Risk of vertical transmission of HIV with no preventative strategies

A

-15-25% in non-breast fed infant, double that if breast fed
- Increasing rates of transmission with increasing viral load (strong correlation)

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7
Q

Risk of transmission of HIV whilst breast-feeding

A

i) Mothers on cART for 6 months and continued BF: overall r/o transmission at 6mths 1.08%, at 12 months 2.93%
ii) Mothers on cART throughout BF period: risk at 6mths 0.3%, risk at 12 months 0.6%

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8
Q

Management of pregnancy with conception on effective cART

A

Antenatal: continue current therapy (some exceptions)
Intrapartum: zidovudine not required
MOD: vaginal delivery if no obstetric contraindication

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9
Q

Management of new diagnosis of HIV in pregnancy, naiive to cART

A
  1. Start cART according to viral genotype results if available
  2. Informed counselling
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10
Q

Management of pregnancy with HIV viral load <50 copies/mL at ≥36 weeks’ gestation

A

Same as for conception of effective cART
Antenatal: continue current therapy (some exceptions)
Intrapartum: zidovudine not required
MOD: vaginal delivery if no obstetric contraindication

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11
Q

Management of pregnancy if HIV viral load >50 coplies/mL at ≥36 weeks’ gestation

A

Intrapartum: Consider intrapartum zidovudine / 3 hours prior to elective CS (esp. if VL >1000)
MOD: Planned CS at 38-39 weeks (esp. if VL >400 (UK) or 1000 (USA))

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12
Q

Management of late-booking, in labour, not on cART

A
  1. Stat dose of nevirapine
  2. Commence cART ASAP
  3. Add raltegravir or dolutegravir to regimen
  4. Intrapartum zidovudine
  5. CS (unless there’s no time)
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13
Q

Nevirapine, raltegravir, tenofovir

A

Readily cross the placenta and are added to ‘pre-load’ the fetus prior to delivery in late presenters

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14
Q

Management of late booking, not in labour, not on cART

A

Presents >28 weeks
- Commence cART ASAP
- Include dolutegravir or raltegravir in regimen
VL unknown or >100,000
- Commence cART ASAP
- Include dolutegravir or raltegravir
- Intrapartum zidovudine and planned CS

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15
Q

When should all women commence cART by and why?

A

By 24 weeks
Earlier virologic suppresion is associated with a lower risk of transmission

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16
Q

Recommended mode of feeding with HIV

A

Formula feeding

17
Q

Optimal scenario for “safe breast-feeding” in HIV

A
  1. Strong engagement with health care
  2. Strong adherence to cART and continuation in BF
  3. Suppressed maternal VL
  4. Exclusive breast feeding ≤6 mths
  5. Avoiding mixed feeding or solids <6months
  6. Attention to breast health and avoiding breast milk from both breast during any episode of mastitis
  7. Suspending breast-feeding if maternal or infant gastro
  8. Do not recommence breast-feeding if formula feeding has been commenced
  9. HIV PCR test of baby 2 months after cessation of breast-feeding
  10. Mat VL monitoring 1-2 monthly while BF
18
Q

Infant PEP: Very low risk category

A
  1. Maternal cART >10 weeks
  2. At least 2 maternal VL <50 during pregnancy, ≥4 wks apart
  3. One VL <50 at ≥36 weeks gestation

Rx: 2 weeks zidovudine monotherapy commencing within 4 hrs of birth

19
Q

Infant PEP: Low risk category

A
  1. Maternal VL <50 at ≥36 weeks gestation
  2. Other ‘very low risk’ criteria not met OR
  3. Infant born <34 weeks’ and most recent VL <50

Rx: 4 weeks zidovudine

20
Q

Infant PEP: High risk category

A
  1. Maternal VL at delivery anticipated / documented >50c/mL or unknown
  2. Uncertainty about maternal adherence to cART

Rx: Triple ARV (zidovudine + lamivudine (4 weeks) + 2 weeks nevirapine)

ASID Guidelines Perinatal Infection (13 decks)

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