HIV in pregnancy BusySpR notes Flashcards
(39 cards)
What is recommended for sexual health screening in pregnant women living with HIV?
Sexual health screening is recommended for pregnant women newly diagnosed with HIV and suggested for women already engaged in HIV care.
This includes screening for genital tract infections according to national guidelines.
What should be completed prior to the initiation of treatment for pregnant women newly diagnosed with HIV?
HIV resistance testing should be completed and results available prior to initiation of treatment, except for late-presenting women (after 28 weeks).
This is to ensure that mutations are not missed during the treatment period.
What is the minimum CD4 cell count monitoring for women conceiving on cART?
There should be a minimum of one CD4 cell count at baseline and one at delivery.
This applies to women conceiving on an effective cART regimen.
When should an HIV viral load be performed for women commencing cART in pregnancy?
An HIV viral load should be performed 2–4 weeks after commencing cART, at least once every trimester, at 36 weeks and at delivery.
This is crucial for monitoring the effectiveness of the treatment.
What should be done if a woman who has initiated cART during pregnancy has not suppressed her plasma viral load?
The following interventions are recommended:
* Review adherence
* Perform resistance test if appropriate
* Consider therapeutic drug monitoring (TDM)
* Optimise to best regimen
* Consider intensification.
These steps aim to improve treatment outcomes.
What modifications are needed for non-standard regimens in pregnant women conceiving on cART?
Non-standard regimens like protease inhibitor (PI) monotherapy should be modified to include one or more agents that cross the placenta.
This ensures the safety and effectiveness of treatment during pregnancy.
What is the recommended starting point for ART in all pregnant women not already on cART?
All pregnant women should start ART during pregnancy and be advised to continue lifelong treatment.
This includes elite controllers.
When should cART be commenced based on viral load in pregnant women?
cART should commence:
* In the second trimester for baseline viral load ≤ 30,000 HIV RNA copies/mL
* At the start of the second trimester for viral load 30,000–100,000 HIV RNA copies/mL
* Within the first trimester for viral load > 100,000 HIV RNA copies/mL or CD4 < 200 cells/mm3.
All women should have commenced cART by week 24 of pregnancy.
What are the recommended nucleoside backbones for women not on cART?
Tenofovir DF or abacavir with emtricitabine or lamivudine as a nucleoside backbone.
This is essential for effective treatment initiation.
What is the recommendation for darunavir/ritonavir dosing in pregnancy?
Darunavir/ritonavir should be prescribed at the twice daily dose (600/100 mg bd) if known resistance.
Consideration should be given to using this higher dose if darunavir is initiated during pregnancy.
What should be done for an untreated woman presenting in labor?
All women should be given a stat dose of nevirapine and commence oral zidovudine, lamivudine, and raltegravir, along with intravenous zidovudine during labor.
This is crucial for preventing vertical transmission.
What is the recommendation for stopping ART postpartum?
Stopping ART after delivery is not recommended; women who wish to stop should be counselled on the risks.
Management should follow BHIVA guidelines.
What should be done upon diagnosis of new HBV infection in pregnant women?
Confirmation of viraemia with quantitative HBV DNA and screening for HAV, HCV, and HDV is recommended.
Tests to assess hepatic inflammation/fibrosis and liver function should also be conducted.
What is the preferred option for the backbone of an antiretroviral regimen in treatment-naïve patients with HIV/HBV co-infection?
Tenofovir DF and emtricitabine or lamivudine should form the backbone.
This is for patients without contraindications.
What should be done for women with both HCV and HIV who wish to become pregnant?
They should be expedited to have DAA-based HCV therapy.
This ensures treatment is optimized before pregnancy.
What is the recommendation for invasive prenatal diagnostic testing in pregnant women with HIV?
Testing should not be performed until after the HIV status is known and ideally deferred until viral load is suppressed to <50 HIV RNA copies/mL.
This minimizes risks to the fetus.
What is the recommended mode of delivery for women taking cART with a plasma viral load of less than 50 HIV RNA copies/mL at 36 weeks?
Planned vaginal delivery should be supported.
This is based on the effectiveness of treatment.
What should be the aim in all cases of term pre-labour SROM?
Delivery within 24 hours should be the aim.
This reduces the risk of transmission.
When should intrapartum intravenous zidovudine be recommended?
For women with viral load over 1000 HIV RNA copies/mL or in whom the current viral load is not known.
This helps prevent vertical transmission during delivery.
What is recommended for the place of birth for women living with HIV?
All women are recommended to give birth in a facility with direct access to pediatric care.
This ensures safety for both mother and child.
What is the recommendation for women living with HIV regarding the place of birth?
All women living with HIV are recommended to give birth in a facility that has direct access to paediatric care.
What is the recommended management for untreated women in labour or with SROM when their HIV viral load is not known?
Intrapartum iv zidovudine infusion can be considered for women on cART with a plasma HIV viral load between 50 and 1000 HIV RNA copies/mL.
What is the recommendation for water births for women living with HIV?
There is scant safety evidence to support water births; however, women should be supported to achieve this if the viral load is less than 50 HIV RNA copies/mL.
What is the duration of zidovudine monotherapy recommended for infants at VERY LOW RISK?
Two weeks of zidovudine monotherapy.
