HIV / AIDS DURING

PREGNANCY

UNDER THE SUPERVISION

PRESENTED BY: OF
LAMNUNNEM HAOKIP DR. SHANTI IDA
MSC (N) 2ND YEAR PROF.CUM HOD (OBG)
SNSR, SU SNSR, SU
INTRODUCTION

• Human Immunodeficiency Virus (HIV)

causes an incurable infection that leads
ultimately to a terminal disease called
Acquired Immunodeficiency Syndrome
(AIDS).
• Worldwide 25 – 30% of infected patients are
women and 90% of them are 20 – 49 years
of age.
 DEFINITION

• Human Immunodeficiency Virus (HIV) : It

belongs to retrovirus family which is the causative
agent of Acquired Immunodeficiency Syndrome
(AIDS).
 
• Acquired Immunodeficiency Syndrome
(AIDS): A disease in which there is a severe loss
of the body's cellular immunity, greatly
lowering the resistance to infection and
malignancy.
IMMUNOPATHOGENESIS

• The target for HIV is the CD4 receptor molecule.

• Cells within the immune system that have this
molecule are : CD4+ T lymphocytes, monocytes,
macrophages and other antigen presenting cells
like fibroblasts, neurons, renal, hepatic and
intestinal cells.
• Following infection, there is profound cellular
immunodeficiency as the CD4+ are progressively
depleted by cytopathic effects of HIV.
Immunological markers that are used to
determine the progression of the disease are as
follows:
• CD4 T lymphocytes count – patients with count
from 200 – 300 cells/mm3 are likely to have HIV
related symptoms and count <200 cells/mm3 is
taken into AIDS defining criteria.
• Measurement of HIV RNA levels by RT-PCR and
the bDNA assays.
MODE OF TRANSMISSION

• Multiple partners, prostitution.

• IV drug abusers
• Multiple transfusion of blood and blood
products
• Parent to child
CLINICAL PRESENTATION

Acute infection syndrome is characterized by:

• Fever

• Skin rash

• Arthralgia

• Lymphadenopathy

• Diarrhoea - This is called seroconversion

illness. It lasts less than 2-3 weeks and

resolves spontaneously.
AIDS related complex refers to subjects
having nonspecific clinical features like:
• Weight loss

• Fever, diarrhoea, herpes simplex, oral or

recurrent genital candidiasis, oral or genital
ulcers.
• Pelvic Inflammatory Disease
• Tubo-ovarian abscess.
• Thrombocytopenia.
PARENT TO CHILD TRANSMISSION

• Vertical transmission to the neonates is about

14 – 25%.
• Trans-placental transmission occurs 20%
before 36 weeks and over 80% of transmission
around the time of labour and delivery.
• Vertical transmission is more in cases with
pre-term birth and with prolonged membrane
rupture.
• Risks of vertical transmission are directly
related to maternal viral load and
inversely to maternal immune status.
• Maternal Antiretroviral Therapy reduces
the risk of vertical transmission by 70%.
• The maximum risk of transmission form
parent to child is the peri-partum period
and intra-partum period.
PREVENTION OF PARENT TO CHILD
TRANSMISSION :

Guidelines by National AIDS Control

Organization (NACO):

• HIV testing is recommended in all pregnant

women which is opt-out approach.

• Antiretroviral therapy is recommended for all

HIV positive women irrespective of their CD4
counts.

• Vaginal delivery is recommended, Caesarean

section is not the only option.
INTERVENTION RISK OF HIV
TRANSMISSION
FROM MOTHER
TO CHILD
No intervention and 30 – 45%
continue breastfeeding

No ART and stop 20 – 25%

breastfeeding

ART and continue 2%

breastfeeding

ART and no 1%
breastfeeding
 PROPHYLAXIS ON
ANTIRETROVIRAL THERAPY(ART)
• Initiate antiretroviral therapy in pregnancy as
soon as diagnosed with HIV positive. Once
started, it should be life-long.

Starting ART for the first time: Triple drug

regime:

• Tenofovir – 300 mg

• Lamivudine – 300 mg

• Efavirenz – 600 mg (considered safe in pregnancy

in all the trimester by world health organization).
Women already on Antiretroviral Therapy

• If the mother is already on ART, she should continue

the regime.

Recommendations for delivery

• Vaginal delivery

• Caesarean section for obstetric indications.

• Minimize the vaginal examination

• Avoid early rupture of membrane.

• Avoid prolonged labour (Oxytocin can be used).

.
• Avoid routine episiotomy.
• Avoid unnecessary instrumentation

• During post-partum, methergine is

avoided because ART drugs and
methergine potentiates increase risk of
hypertension.
• According to world health organization,
there is no rush in early cord clamping.
Recommendations for Infant Prophylaxis
• After birth the infant should also get ART
prophylaxis irrespective of the mode of feeding
of the infant (breastfed and replacement fed
babies).
• Mother who has taken ART more than 4 weeks
during pregnancy, the infant should be given
Syrup Nevirapine for 6 weeks after delivery /
birth.
• Mother has taken ART less than 4 weeks
during pregnancy, the infant should be
given Syrup Nevirapine for at least 12
weeks.
• For a mother who took Nevirapine in the
past or previous pregnancy, for the infant
Syrup Zidovudine.
STANDARD SAFETY MEASURES

Prenatal Care:
• Screening should be offered voluntarily.
• Counselling about the risks of HIV
transmission from parent to child.
• Tuberculin test should be test to find out
any associated factors which can leads
to HIV/AIDS.
Intra-partum Period

• Avoid instrumentations during labour.

• Careful handling of fluids of the mother.

• Use of personal protective equipment.

Post-partum Period

• Counsel regarding the breastfeeding and

help to informed choice.

• Keeping the perineal area clean with

antiseptic solutions to prevent infections
The followings are the safety measures to prevent form
transmission of HIV/AIDS from one person to another:
• HIV testing and linkage to care, HIV medications and
Access to condoms
• Prevention programs for people with HIV and their
partners
• Prevention programs for people at high risk for HIV
infection
• Substance abuse treatment and access to sterile syringes
• Sexually Transmitted Infections screening and treatment.
• Use of personal protective equipments.
 SUMMARY
&
CONCLUSION
BIBLIOGRAPHY / REFERENCE
• DC Dutta’s. Hiralal Konar. Textbook of
Obstetrics. 8th Edition. Jaypee The Health
Sciences Publishers. Page no. 350 – 353.
• Anamma Jacob. A cComprehensive Textbook of
Midwifery and Gynaecological Nursing. Fourth
Edition. Jaypee The Health Sciences Publishers.
Page no. 321 – 323.
• DC Dutta’s Hiralal Konar. Textbook of
Gynaecology. 7th Edition. Jaypee the health
sciences publishers. Page no.126 – 128.
• Park K. Park’s Textbook of Preventive and
Social Medicine, twenty fifth edition. Banarsidas
Bhanot Publishers; page no. 310 – 8.
• https://youtu.be/xIOqLQGQthQ
• https://www.acog.org/womens-health/faqs/hi
v-and-pregnancy#:~:text=During%20pregna
ncy%2C%20HIV%20can%20pass,breaks%2
0(her%20water%20breaks)
.
• Royal College of Obstetricians and
Gynaecologists, Royal College of Midwives,
Royal College of Anaesthetists, Royal
College of Paediatrics and Child Health.
Standards for Maternity Care. Report of a
Working Party. London: RCOG Press; 2008
[http://www.rcog.org.uk/
womens-health/clinical-guidance/standards-
maternity-care].