HIV infection in pregnancy

HIV INFECTION IN PREGNANCY/ACQUIRED IMMUNODEFICIENCY SYNDROME

Mostly spread through heterosexual contacts, but blood transfusions/blood component therapy, intravenous drug abuse and vertical transmission in pregnancy from mother to foetus help to spread the disease.

Incidence

0.5-2.0% of pregnant women are affected. Progress of the disease:

Acquisition of infection: This occurs as detailed above.

Primary HIV infection: Patient gets sero +ve 2-8 weeks later.

Asymptomatic HIV infection: The patient is an asymptomatic carrier of the disease for many years. They spread the disease.

Late symptomatic HIV infection: ARC (AIDS-related complex) develops later on, characterized by generalized lymph node enlargement, fever, night sweats, weight loss, and opportunistic infections.

Advanced HIV infection: Full blown AIDS is the result of severe dysfunction of the immune system leading to death.

Diagnosis

All pregnant women should be ideally screened for HIV infection after proper counselling. All patient's information is treated as confidential.

Enzyme-linked immunosorbent assay (ELISA) test for HIV, if positive.

Reconfirm the test.

Confirm by Western blot test if positive proceed as follows.

CD4 cell count to determine severity of the disease.

Viral cultures and PCR testing for special needs.

Test all contacts for HIV.

Effect of pregnancy on HIV

Progression of the disease may be enhanced.

Risk of vertical transmission from mother to infant.

Greater possibility of asymptomatic HIV infection to progress to full blown AIDS.

Effect of HIV on pregnancy:

There is no increase in risk of preterm birth, low birth weight or foetal malformations.

Management

Screen for other STDs and tuberculosis in our country.

USG confirmation of pregnancy and dating.

Counselling for MTP.

Monitoring foetal growth and wellbeing.

Serial monitoring of CD4 counts in each trimester, if <500 start antivir treatment. If >500 consider obstetric care.

Antiviral prophylaxis therapy—oral zidovudine (AZT) to diminish the risks of vertical transmission of the disease. The drug is well tolerated and non-teratogenic. It inhibits reverse transcriptase.

Mothers to receive vaccinations for HBV and influenza.

Prescribe sulphamethoxazole-trimethoprim and aerosolized pentamidine prophylaxis for P. carinii pneumonia.

Treat vaginal candidiasis with miconazole.

It is advisable to deliver patient by elective caesarean section to minimize vertical transmission of HIV.

Protect all attendants from HIV risks by strict barrier nursing, proper disposal of linen and disposables.

Breast milk permitted in India for the poorer masses.

Management of the newborn

Precautions with blood and body fluids.

Prophylactic AZT for 6 weeks.

Testing for the p24 core antigen.