HIV in Pregnancy Flashcards
(51 cards)
How much vertical transmission of HIV is lowered by treatment ?
Without treatment 👉25 - 40 %
HAART + Avoid breastfeeding 👉 1%
cART+undetectable viral load👉0.5%
how long does it take for HIV antibodies test & HIV P24 antigen test to be detectable after infection?
HIV antibodies test 👉 may take up to 3 months
HIV P24 antigen 👉 within 1 month of infection
What is the role of rapid HIV tests in screening pregnant women?
Women of unknown status who present in labour( takes 20 minutes)
What is the incidence of depression in women with HIV?
30 - 50 %
When should assessment of depression be undertaken in women with HIV ?
At booking
4 - 6 weeks postpartum
3 - 4 months postpartum
How to asses depression in women with HIV?
Whooley questions
When to break confidentiality with women diagnosed with HIV ?
In order to inform a sexual partner
If appears to want to delay telling
What is the incidence of STD in women with HIV ? When to screen?
0- 4 %
Screening is recommended if the pregnant woman newly diagnosed with HIV
Screening is suggested if she is living with HIV
What are the baseline investigations required in pregnant women who are newly diagnosed with HIV ?
No additional baseline investigations required ( as performed in general antenatal clinic )
In pregnant women commencing cART in pregnancy what are the additional baseline investigations required ?
LFTs : performed as routine initiation of cART & then with each routine blood test
Why to monitor LFTs in pregnant women commencing cART ?
Hepatotoxicity may occur as a result of the initiation of cART
Or development of obstetric complications ( HELLP - obstetric cholestasis - preeclampsia - acute fatty liver)
In women conceiving on cART when to measure CD4 count ?
Baseline
At delivery
In women who commence cART in pregnancy , when CD4 count should be performed?
At initiation of treatment
At delivery
In women who commence cART in pregnancy, when should HIV viral load be performed?
2 - 4 weeks of starting treatment
Each trimester
36 week
At delivery
When to do HIV resistance testing?
Prior to initiation of treatment
Except: late presenting women
( > 28w)
If they choose to stop cART further HIV resistance testing should be done
What medications from cART that has possible adverse fetal outcomes? How to manage?
DOLUTEGRAVIR
Possible neural tube defects
if she is trying to conceive or in the first trimester 5 mg of folic acid
If she isn’t on that drug 👉400mcg
What are the Elite controllers?
People with HIV who maintain an undetectable viral load and high CD4 counts without treatment
How long a pregnant woman with HIV will be on medications?
Lifelong including elite controllers
When to start cART in women with HIV positive in pregnancy?
First trimester: if
Viral load > 100,000 or
CD4 < 200
At the start of 2nd trimester: if
Viral load 30,000 - 100,000
2nd trimester: if
Viral load < 30,000
🚩 all women should have started cART by 24w of pregnancy
What is the management in pregnant women with HIV positive who present > 28w or in labour and not on treatment?
Commence cART immediately
& IV zidovudine during labour
What are the investigations that should be done in a pregnant woman with HIV &new HBV infection ?
LFTs
HBV DNA quantitative
Antigen e
HAV + HCV + HDV screening
How to manage HAV non immune pregnant woman with HIV+ & HBV ?
Vaccination after 1st trimester
as per normal schedule
( 0 - 6 months)
If CD4 < 300 👉 ( 0 - 1 - 6 months)
What is the mode of delivery recommended if the woman has fully suppressed HIV viral load on cART & HBV infection?
Vaginal birth irrespective of HBV viral load
Among HCV medications , which drug is contraindicated in pregnancy?
Ribavirin ( directly acting antiviral DAA)
If the woman is trying to conceive or discovers she is pregnant should discontinue the drug
