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Neonate > Prevention of mother- to -child transmission (PMTCT) of HIV > Flashcards

Prevention of mother- to -child transmission (PMTCT) of HIV Flashcards

1
Q

What are the transmission risks of HIV from mother-to-child without PMTCT intervention?

A

HIV may be transmitted during pregnancy (5%), labor and delivery (15%), and breastfeeding (15%).

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2
Q

When does the transmission risk of HIV peak during labor and delivery?

A

The transmission risk of HIV peaks during the eight to 12 hours of labor and delivery.

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3
Q

What is the primary determinant of HIV transmission from mother-to-child?

A

High maternal viral load is the primary determinant of transmission at all stages.

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4
Q

How can women on antiretroviral therapy (ART) prevent HIV transmission to their infants?

A

Women on ART with suppressed viral loads are unlikely to transmit HIV to their infants through pregnancy or extended breastfeeding.

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5
Q

What is critical to optimizing HIV-free survival in infants?

A

Optimizing maternal ART and supporting breastfeeding are critical to optimizing HIV-free survival.

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6
Q

What is the goal of Universal Test and Treat (UTT) policy?

A

The goal of UTT is to identify 90% of people with HIV, treat 90% of them, and achieve a 90% rate of viral suppression (90-90-90 WHO).

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7
Q

What are the consequences for infants infected with HIV in utero?

A

Infants infected in utero experience rapid disease progression and high morbidity and mortality unless treated promptly.

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8
Q

How has PMTCT impacted child and maternal mortality in the last decade?

A

PMTCT has significantly reduced child and maternal mortality in the last 10 years, with transmission rates reduced to less than 1%.

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9
Q

What does South African PMTCT policy require regarding antenatal HIV testing?

A

South African PMTCT policy requires repeated antenatal HIV testing, including poorly implemented partner testing.

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10
Q

What is the first-line ART regimen for newly diagnosed and known HIV positive women in South Africa?

A

Newly diagnosed and known HIV positive women are initiated on ART, typically a fixed-dose combination of Tenofovir, Emtricitabine, and Efavirenz.

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11
Q

What is recommended for women with virological failure after 12 weeks of ART during pregnancy and breastfeeding?

A

Women with virological failure after 12 weeks of ART during pregnancy and breastfeeding require intensified adherence support and may need to be switched to 2nd-line ART if still failing despite good compliance.

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12
Q

What is crucial for PMTCT and maternal health?

A

Viral suppression is crucial for PMTCT and maternal health.

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13
Q

How does South African PMTCT policy reduce transmission risk during labor for women with no pre-labor ART?

A

Intrapartum rescue ARV regimens, followed by enhanced infant post-exposure prophylaxis, are used to reduce transmission risk during labor for women with no pre-labor ART.

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14
Q

What shows promise for women with poor viral control in PMTCT, although not yet policy for prevention?

A

Strand integrase inhibitors, such as Dolutegravir, show promise for women with poor viral control in PMTCT, although they are not yet policy for prevention.

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15
Q

How is infant management categorized in PMTCT?

A

Infant management is categorized by risk category.

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16
Q

What factors increase the risk of in utero transmission of HIV?

A

In utero transmission risk is increased if the disease is advanced, there is new infection during pregnancy, or ART was started less than 12 weeks before delivery.

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17
Q

What increases the risk of intrapartum transmission of HIV?

A

Intrapartum transmission risk is increased if maternal viral load is greater than 1000 copies/ml at the time of delivery.

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18
Q

What increases the risk of postpartum transmission of HIV?

A

Postpartum transmission risk is increased if maternal viral load is unsuppressed or there is viral rebound during breastfeeding.

19
Q

What is the transmission risk for infants when mothers are on ART with suppressed viral loads through pregnancy?

A

Infants whose mothers are on ART with suppressed viral loads through pregnancy have a low risk for transmission.

20
Q

How are infant testing and prophylaxis regimens adjusted based on risk?

A

Infant testing and prophylaxis regimens are boosted when the risk is not low.

21
Q

Why is nucleic acid amplification testing (NAAT or PCR) necessary for HIV testing in infants?

A

NAAT or PCR testing is necessary because trans-placental transfer of maternal antibodies can invalidate antibody testing in infants.

22
Q

How is in utero transmission of HIV detected in infants?

A

In utero transmission is detected by routine testing of all HIV-exposed infants at birth.

23
Q

How is intrapartum transmission of HIV detected in infants?

A

Intrapartum transmission is detected by repeat testing at ten weeks and, in high-risk exposures, again after 18 weeks.

24
Q

How is breastfeeding transmission of HIV detected in infants?

A

Breastfeeding transmission is detected by age-appropriate testing six weeks after the final breastfeed.

25
Q

When should malnourished, acutely unwell, or growth faltering HIV-exposed infants be tested?

A

Malnourished, acutely unwell, or growth faltering HIV-exposed infants should be tested by age-appropriate tests.

26
Q

When is antibody testing recommended for HIV testing in infants?

A

After 18 months, antibody testing is recommended as almost all infants will have cleared maternal antibodies.

27
Q

How does infant post-exposure prophylaxis impact HIV transmission?

A

Infant post-exposure prophylaxis from soon after birth reduces the frequency of intrapartum transmissions but cannot reduce in utero transmission.

28
Q

What reduces breastfeeding transmission of HIV to very low rates?

A

Maternal ART or extended infant ARV prophylaxis reduces breastfeeding transmission to very low rates.

29
Q

What is the reported impact of combination ARV infant post-exposure prophylaxis when there has been no pre-labor ART?

A

Combination ARV infant post-exposure prophylaxis has been reported to halve the frequency of intrapartum transmission compared with a single agent when there has been no pre-labor ART.

30
Q

What prophylactic regimen is recommended for infants of mothers who are virally suppressed on ART close to delivery?

A

Infants whose mothers are virally suppressed on ART close to delivery are given daily prophylactic Nevirapine syrup only until six weeks of age. Thereafter, maternal ART makes breastfeeding safe.

31
Q

What prophylactic regimen is recommended for infants of mothers who are virally unsuppressed close to delivery?

A

Infants whose mothers are virally unsuppressed close to delivery are given combination prophylaxis for 6 weeks to reduce intrapartum transmission. Infant combination prophylaxis is currently Zidovudine and Nevirapine.

32
Q

When do formula-fed infants stop ARV prophylaxis?

A

Formula-fed infants stop ARV prophylaxis at six weeks.

33
Q

How long should breastfed infants continue with Nevirapine monotherapy for prophylaxis?

A

Breastfed infants should continue with Nevirapine monotherapy for a minimum of twelve weeks until the maternal viral load is suppressed.

34
Q

What prophylactic treatment should all HIV-exposed infants receive from 6 weeks?

A

All HIV-exposed infants should be started on prophylactic co-trimoxazole from 6 weeks until HIV infection has been excluded.

35
Q

What should be done regarding routine immunizations for HIV-exposed infants?

A

HIV-exposed infants, whether infected or not, should receive routine immunizations.

36
Q

Should BCG be administered to infants known to be HIV-infected?

A

No, BCG should not be given to infants known to be HIV-infected.

37
Q

What is the mortality risk associated with never breastfeeding in low-resource settings?

A

Never breastfeeding incurs a significant mortality risk, including malnutrition, pneumonia, and gastroenteritis, which is greater than the risk of HIV transmission.

38
Q

What is the current default feeding policy in South Africa?

A

The current default feeding policy in South Africa is exclusive breastfeeding for the first 6 months of life, followed by the addition of complementary food while continuing to breastfeed to 2 years or more (previously only 12 months).

39
Q

What should mothers be taught regarding breastfeeding techniques?

A

Mothers should be taught correct latching and breastfeeding techniques to prevent cracked nipples and mastitis.

40
Q

What did the 2017 feeding policy update recommend regarding infant feeding in the context of HIV?

A

The 2017 feeding policy update normalizes infant feeding in the HIV context and recommends that ART and breastfeeding be supported systemically.

41
Q

What does the 2017 feeding policy update recommend regarding exclusive breastfeeding?

A

The 2017 feeding policy update promotes exclusive breastfeeding for six months but discourages stopping breastfeeding if it is not exclusive or only possible for a shorter duration.

42
Q

What alternatives to breastfeeding are mentioned in the update, especially for neonatal units?

A

Pasteurized own mother’s milk or donor milk can be used, especially in neonatal units.

43
Q

Under what circumstances should formula feeding be considered according to the update?

A

Formula feeding should only be considered if safety criteria are met or if the mother is failing 2nd or 3rd line ART.

44
Q

Why is feeding support especially necessary for some mothers, according to the update?

A

Feeding support is especially necessary for mothers whose home circumstances are not safe for replacement feeding.

Neonate (34 decks)

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