HIV (+) pregnant woman

Prophylaxis of mother-to-child transmission

Manegemant of a woman, who needs ARV medication

HIV mother-to-child transmission

No embryopathy is observed. Newborns are asymptomatic.

Virus may be transmitted - transplacentally - during labor - by breastfeeding

Risk depends on stage of infection in mother ( HIV

viremia)

Risk about 25 % (Western/Central Europe, USA) 40% (Africa)

HIV mother-to-child transmission

Newborn infection rate is related to mother`s viremia :

-viremia > 100 000 copies/ml - 41% -viremia 1000 - 10 000 copies/ml - 17% -viremia < 1 000 copies/ml - ~ 0%

N. Engl. J. Med., 1999,341,394

Prophylaxis of mother-to-child transmission

Antiretroviral treatment - cART in pregnancy starting at 16 – 28 week - Retrovir iv in a drip during labor: bolus 2 mg/kg (1 h), then 1 mg/kg/h until umbilical cord is clamped - newborn : Retrovir 4 mg/kg (syrup) every 12 h for 4

weeks (or cART if mother’s viremia is detectable)

Caesarean section prior to amniotic membranes rupture (if viremia > 50 copies/ml)

Newborn should be washed

No breastfeeding Transmission rate has

dropped to < 2 %

cART in pregnancy

Combivir 1 tabl bid (Retrovir + 3TC)

Kaletra 2 tabl bid

Also accepted: Viramune, Invirase

Videx, Zerit, Ziagen...

Not recommended: Stocrin, Hivid

Prophylaxis of mother-to-child transmission

About 36th week of pregnancy:

- test HIV viremia

- provide a woman with „labor set” Retrovir iv 1 vial

Retrovir liquid 1 bottle

- consider the mode of delivery

caesarean section vaginal delivery

HIV viremia > 50 copies HIV viremia < 50 copies

Mother`s seropositivity diagnosed during labor

cART in mother,Retrovir iv during labor,

Cesarean section (prior to amniotic membranes rupture)

Retrovir in the newborn for 4 weeks

+ Viramune for 2 weeks (sometimes Kaletra for 4 weeks)

+ Epivir for 4 weeks

If necessary continue cART in the mother

Prophylaxis of mother-to-child transmission – a case

Patient aged 24, infected through intravenous drug use, seropositivity known since 4 years

Admitted for check up in week 21 of pregnancy CD4 count 371 cells/mm3 HIV viremia 89 700 copies/ml

Since week 22 of pregnancy she was given: Retrovir + 3TC + Kaletra

Check up in week 36 of pregnancy: CD4 count 327 cells/mm3 HIV viremia <50 copies/ml

She has delievered by caesarean section in week 40 of pregnancy

During labor Retrovir iv was administered, newborn was given Retrovir in syrup

Baby is not infected