Pregnancy Flashcards
(25 cards)
PCP in pregnancy treatment
Septrin is treatment of choice
Also prophylaxis of choice even in 1st trimester
Primaquine NOT recommended due to risk of haemolytic in G6PD deficiency
Vaginal candidiasis in pregnancy
Topical clotrimozale or miconazole for 7 days
Oropharyngeal candidiasis in pregnancy
First line TOPICAL nystatin or Amphoterecin B
AVOID systematic azoles
Systematic ambisome is 2nd line
Cryptococcal infection in pregnancy
FIRST trimester - Ambisome ONLY
2nd/3rd trimester - Ambisoke + flucytosine
Maintanence & secondary prophylaxis- Ambisome
AVOID fluconazole. Except in 2nd & 3rd trimester if no alternatives.
Toxoplasmosis in pregnancy
1st line - Pyrimethamine (plus colic acid) + sulfadiazine
2nd line - Clindamycin + pyrimethamine/atovaquone
Avoid sulfadiazine after 32 weeks
CMV in pregnancy
Ganciclovir
Screen for congenital CMV in baby
MAC in pregnancy
Rif + azithro + ethambutol
Primary prophylaxis ONLY if CD4 <50 and NOT on ART
HIV resistance testing in pregnancy
HIV resistance testing should be completed and results available prior to initiation of treatment, except for late-presenting women (after 28 weeks).
CD4 & VL monitoring in pregnancy
In women who commence cART in pregnancy, a CD4 cell count should be performed as per routine initiation of cART with the addition of a CD4 count at delivery even if starting at CD4 > 350
In women who commence 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.
Difference in folic acid in pregnancy
Women taking dolutegravir who are trying to conceive or in the first trimester of pregnancy (<12 weeks’ gestation) should be recommended to take folic acid 5 mg od (standard dose 400mcg OD)
ART in pregnant elite controllers
Recommended.
When to start ART in pregnancy
• As soon as they are able to do so in the second trimester where the baseline viral load ≤30,000 HIV RNA copies/mL;
• At the start of the second trimester, or as soon as possible thereafter, in women with a baseline viral load of 30,000–100,000 HIV RNA copies/mL;
• Within the first trimester if viral load >100,000 HIV RNA copies/mL and/or CD4 cell count is less than 200 cells/mm.
All women should have commenced cART by week 24 of pregnancy.
Recommended ART regimen in pregnancy
TDF/abacavir PLUS
Emtricitabine/LAM PLUS
efavirenz or atazanavir/r
Alternative: Rilpivirine (25 mg od), raltegravir (400 mg bd) or darunavir/r (600/100 mg bd
Dolutegravir in pregnancy
50mg OD after 6 weeks of gestation
TAF in pregnancy
After 1st trimester
Late presenter - High or unknown VL in pregnancy
3-4 drug regimen including Ral 400 BD or Dol 50 OD
Untreated women presenting in labour at term
- Stat nevirapine 200
- Oral AZT 300 + LAM 150 BD
- Ral 400 BD
- IV AZT for duration of labour
Mode of delivery in HIV pregnancy
- < 50 copies/mL @ 36w - Normal vaginal
- 50-399 - Consider CS
- > 400 - LSCS
Intrapartum AZT indications
- Untreated women in labour
- VL > 1000
- Consider in VL 50-1000
Infant PEP categories
- VERY LOW RISK:
- mum on ART > 10 weeks &
- 2 VLs <50 at least 4 weeks apart
- VL <50 after 36 weeks
AST mono therapy for 2 WEEKS
- LOW RISK
- if above criteria not fully met but VL < 50 after 36 weeks
- Prem (<34 weeks) but mum VL < 50
AZT mono therapy for 4 WEEKS
- HIGH RISK
TRIPLE drugs for 4 weeks
HIV2 High risk infant PEP
AZT + LAM + RAL
Infant HIV testing
- NON breast fed
PCR
< 48 hours after birth & before discharge
2 weeks (HIGH RISK ONLY)
6 weeks (2 weeks after PEP)
12 weeks
Ab testing
22-24 months for seroconversion
- BREAST FED
PCR
< 48 hours after birth & before discharge
2 weeks
Monthly
4 & 8 weeks after stopping BF
Ab testing
22-24 months for seroconversion
8 weeks after BF stopping if after 24 months age
HIV Post partum requirements
- Review at 4-6 weeks
- Smear at 3 months
Women conceiving on ART
Recommended to continue same regimen due to risk of virological failure
Except Ral - make it BD!
