Care of

pregnant
woman living
with
Group 16
HIV/AIDs
 Objectives
1. Define HIV/AID
2. Pathophysiology of the virus in the body
3. Explain ways to prevent perinatal transmission of HIV
4. Describe the medical management of pregnant woman
living with HIV/AIDS.
5. Explain the nurse’s role in care for a mother with
HIV/AIDS during and after pregnancy.
What is
HIV?
 What is HIV?
HIV is an abbreviation for  Human
Immunodeficiency Virus. It can spread through
sexual contact, injection, drug use or sharing needles,
contact with infected blood, or from mother to child
during pregnancy, childbirth or breastfeeding. HIV
destroys CD4 T cells which are white blood cells that
play a large role in helping your body fight diseases
(Centre of Disease Control and Prevention,2022).
What is
AIDs?
 What is AIDs?
Aids is an abbreviation for Acquired Immune
Deficiency Syndrome. The name is used to describe a
number of potentially life-threatening infections and
illnesses that happen when your immune system has
been severely damaged by the HIV virus. While
AIDS cannot be transmitted from one person to
another, the HIV virus can(Centers of Disease
Control and Prevention, 2022)
Pathophysiology
 Pathophysiology
• When a person is infected with HIV, it attacks the
immune system. There are many white blood cells in
the immune system that fights infections. HIV finds the
white blood cell- CD4 cells and makes copies of itself.

• The new copies of the virus find other the CD4 cells
and starts the cycle again.
 Pathophysiology
• In return, the immune system tries to make more CD4
cells to fight the virus but when it is unable to do so, the
CD4 cell count falls. This causes the infected host to
become sick- as their immune system becomes weak.
(Chapter 1 HIV: The Basics - New York State
Department of Health,n.d)
 Pathophysiology
• Acquired Immune Deficiency Syndrome (AIDS) occurs when HIV has
severely damaged the immune system. According to HIV AIDS
pathophysiology (2020), AIDS has a complicated pathophysiology. It is
caused by HIV as a result of depleted CD4 helper T cells.

• This weakens the immune system and allows for opportunistic infection
because T-lymphocytes, which are required for immune response and
defense against these infections, are reduced. (HIV AIDS
pathophysiology,2020)
 Pathophysiology
• In pregnant women, HIV can be passed from mother to child.
The article ‘HIV and pregnancy’ (2020), outlined that HIV is
passed through the placenta to infect the fetus.

• Additionally, the virus from the mother’s blood can be

exposed to the baby during labor. Once the amniotic sac
breaks the risk of transmission increases and most babies are
infected around time of delivery.
 Pathophysiology
• Infected host may experience flu like symptoms
that may go away without treatments, however,
HIV stays in their blood and grows and destroys
their immune system.
 Pathophysiology

•  Infants born with HIV or acquired it from their mother’s

breast milk may have symptoms, but not limited to; slow to
grow and gain weight, frequent diarrhea, slow learning to walk
and talk, yeast infections (thrush). (Chapter 1 HIV: The Basics
- New York State Department of Health,n.d)
 Ways to prevent
perinatal transmission
of HIV
 Ways to prevent perinatal transmission
of HIV
• Women with HIV who are trying to conceive should start
HIV drugs before they become pregnant to prevent
perinatal transmission of HIV.

• To avoid perinatal transmission of HIV, pregnant women

with HIV should take HIV medications throughout
pregnancy and childbirth. Additionally, when taken as
directed, lower the body's level of HIV (also known as the
viral load) and stop it from spreading.
 Ways to prevent perinatal transmission
of HIV
• When a woman with HIV has an undetectable viral load, the
risk of perinatal transmission of HIV during pregnancy and
childbirth is the lowest.

• Babies born to HIV-positive mothers are given HIV

medications after delivery to lower the risk of perinatal
HIV transmission. 
 Ways to prevent perinatal transmission
of HIV
• HIV-positive women who are expecting are urged to
discuss their options for feeding their unborn child with
their medical team. The risk of transmission to a breastfed
baby is low: less than 1%, but not zero, with regular use of
HIV treatment and an undetectable viral load during
pregnancy and throughout breastfeeding.

• Alternatives that reduce the danger of transmission to a

newborn include appropriately prepared formula and
pasteurized donor human milk from a milk bank.
 Ways to prevent perinatal transmission
of HIV
• Babies should also not consume food that has been
previously chewed by an HIV-positive individual. (US
Department of Health Services, 2023)
 Medical
management
 Medical Management
Screening
• It is recommended that expectant mothers who have HIV should be provided
with peer assistance, if such support is accessible. Antenatal and postnatal
depression evaluations should be conducted during booking, 4-6 weeks following
childbirth.

• To ensure comprehensive care, pregnant women diagnosed with HIV should

undergo screening for sexual health concerns. Except for women presenting after
28 weeks, complete drug resistance testing for HIV should be conducted prior to
initiating treatment.
 Medical Management

• During pregnancy, it is recommended to perform a CD4 cell count at the start

of combination antiretroviral therapy (cART). An additional CD4 count should
be conducted at the time of delivery. For pregnant women who begin cART, it
is important to monitor the effectiveness of treatment through regular HIV viral
load testing. HIV viral load testing is recommended two to four weeks after
starting cART, at least once every trimester, at 36 weeks gestation, and at the
time of delivery.
 Medical Management
 Furthermore, liver function tests should be performed in women who
commence cART during pregnancy. These tests should be performed as part
of routine blood work and repeated regularly to monitor any changes in liver
function.

 If a pregnant patient has started cART during pregnancy but has not
achieved suppression of plasma viral load to less than 50 HIV RNA
copies/mL, it is important to evaluate the reasons for this lack of response.
An adherence review should be conducted to assess whether the patient is
consistently taking the medication as prescribed.
 Medical Management
Antiretroviral Therapy  (ART) During Pregnancy
• For patients who are planning to conceive and are already
receiving effective cART treatment, it is recommended to
continue this treatment during pregnancy.

• In cases where a woman is pregnant, it is advised to initiate

ART treatment and to advise her to continue taking it for
life, even if she is an elite controller.
 Medical Management
Antiretroviral Therapy  (ART) During Pregnancy

• If the baseline viral load is ≤30,000 HIV RNA copies/mL, cART

treatment should be started in the second trimester. If the baseline viral
load is 30,000-100,000 HIV RNA copies/mL, treatment should be
initiated at the start of the second trimester. If the viral load is >100,000
HIV RNA copies/mL and/or CD4 cell count is less than 200 cells/mm3,
treatment should be started within the first trimester. All women should
have started cART by the 24th week of pregnancy.
(Adleman, 2021)
 Medical Management
Antiretroviral Therapy  (ART) During Pregnancy

• Efavirenz or atazanavir/r are recommended as the third cART agent.

Alternatives include rilpivirine (25 mg once daily), raltegravir (400 mg
twice daily), or darunavir/r (600/100 mg twice daily). Dolutegravir (50
mg once daily) may be considered after confirmed 8 weeks’ gestation.

• Zidovudine monotherapy should only be used in women declining cART

with a viral load of < 10,000 HIV RNA copies/mL and having a cesarean
section.

(Adleman, 2021)
 Medical Management
Antiretroviral Therapy  (ART) During Pregnancy
• All women who have been untreated and present in labor at term should
be given a stat dose of nevirapine 200 mg and start oral zidovudine 300
mg and lamivudine 150 mg twice daily.

(Adleman, 2021)
 Medical Management
Antiretroviral Therapy  (ART) During Pregnancy

• Routine antiretroviral doses should not be altered, except for raltegravir,

which should be given as 400 mg twice daily.

• ART treatment should not be stopped after delivery and women who
request to stop ART should be counseled on the risks.

• For women with HIV-2, a boosted PI-based regimen such as twice daily
darunavir/r is recommended.
(Adleman, 2021)
 Medical Management
● Resistance testing should also be recommended to
determine if the patient has developed any drug-resistant
strains of HIV, which may require a change in treatment.
● Regimen optimization may be necessary to switch to a
more potent, better-tolerated regimen that is appropriate
for the patient's stage of infection. If optimization is not
enough, treatment intensification may be considered by
adding additional antiretroviral agents to the patient's
regimen. (Adleman, 2021)
The nurse’s role in caring
for a mother with
HIV/AIDS during and
after pregnancy
 Nurse’s role

1. Education and counseling: The nurse should educate the

patient on the risks associated with HIV infection during
pregnancy and the measures that can be taken to prevent
transmission to the fetus. The nurse should also provide
counseling to the patient on the importance of adhering to
antiretroviral therapy (ART) and the potential side effects of
these medications.
 Nurse’s role
2. Monitoring and assessment: The nurse should monitor the
patient's viral load, CD4 count, and other laboratory values
regularly to assess the effectiveness of ART. The nurse should
also assess the patient's general health, including weight, blood
pressure, and other vital signs, and monitor for any signs of
opportunistic infections.
3. Prevention of transmission: The nurse should educate the
patient on strategies to prevent transmission of HIV to the fetus,
such as elective cesarean delivery, ART during pregnancy and
breastfeeding, and avoidance of breastfeeding and also adhering
to the regimen to ensure health of both mother and child.
 Nurse’s role
4. Psychosocial support: Mothers with HIV/AIDS are often
stigmatized, which leads to depression, anxiety and isolation. The nurse
should provide emotional support to the patient, as well as support for
any family members who may be affected by the patient's diagnosis.
The nurse should also refer the patient to support groups and other
resources as needed.
5. Collaboration with other healthcare providers: The nurse should
collaborate with the patient's healthcare team, including physicians,
social workers, and other specialists, to ensure coordinated care for the
patient.
 References
About HIV/AIDS | HIV Basics | HIV/AIDS | CDC. (n.d.).

https://www.cdc.gov/hiv/basics/whatishiv.html#:~:text=What%20is%20HIV%3F,they%20have%20it%20for%20lif

Adleman, R. (2021, November 21). Management of HIV in Pregnancy Information Leaflet. Patient.info.

https://patient.info/doctor/management-of-hiv-in-pregnancy

Cachay, E. R. (2023, March 15). Human immunodeficiency virus (HIV) infection - infectious diseases. MSD Manual

Professional Edition. Retrieved March 21, 2023, from

https://www.msdmanuals.com/professional/infectious-diseases/human-immunodeficiency-virus-hiv/human-immun

odeficiency-virus-hiv-infection#:~:text=Pathophysiology%20of%20HIV%20Infection,released%20into%20the%20
 References
Chapter 1 HIV: The Basics - New York State Department of Health. (n.d.).
https://www.health.ny.gov/diseases/aids/general/resources/child/docs/chapter_1.pdf

HIV AIDS pathophysiology. wikidoc. (2020, July 29).

https://www.wikidoc.org/index.php/HIV_AIDS_pathophysiology#:~:text=The%20pathophysiolo
gy%20of%20AIDS%20is,the%20inhibition%20of%20neoplastic%20proliferation
.

HIV and pregnancy. ACOG. (2020, January).

https://www.acog.org/womens-health/faqs/hiv-and-pregnancy

U.S. Department of Health and Human Services. (2023, January 31). Preventing perinatal transmission
of HIV. National Institutes of Health.
https://hivinfo.nih.gov/understanding-hiv/fact-sheets/preventing-perinatal-transmission-hiv#:~:te
xt=Perinatal%20transmission%20of%20HIV%20is,to%2Dchild%20transmission%20of%20HIV
.