HIV / AIDS IN PREGNANCY

 MTCT is the commonest mode of HIV transmission in children.

 Also referred to as vertical transmission

 Accounts for 95% of all paed HIV cases

Facts of MTCT

 Transmission can occur anytime during pregnancy, labour & puerperium

 Breast milk contains HIV

 MTCT is 15-30% in non-breastfeeding population without intervention

 Risk increases to 20-45% in breastfeeding popn without intervention.

 Known interventions can reduce MTCT up to as low as 2%

 Highest risk of transmission is during labour, in early & late stage disease.

TIMING OF MTCT

 In Utero 15 - 20%

 During labour 60 - 70%

 Breastfeeding 15 - 20%

PMTCT

 Refers to Prevention of Mother To Child Transmission of HIV

 Primary level prevention by preventing women from getting HIV

 Secondary prevention is by proper management of HIV positive pregnant women

 It is not meant to encourage HIV positive women to get pregnant.

The four prongs of PMTCT include:

 Primary prevention of HIV esp among women of child bearing age

 Prevention of unintended pregnancies among the HIV + (counsel on family planning

use)
  Reduction of MTCT among HIV+ pregnant women (ensure HIV testing and access to
ARV drugs)

 Provision of treatment, care & support to HIV+ women, their infants & families

Comprehensive package for people living with HIV/AIDS

 Use of ITNs

 clean water and sanitation

 Nutrition

 TB screening and treatment

 Septrin therapy

 Treatment of opportunistic infections

 ARV therapy

OPTION A

This included: women with CD4<350 or stage 3 -4, eligible for treatment, women with
CD4>350, AZT at 28 weeks, SD-NVP + AZT + 3TC intra-partum and seven days post partum of
maternal AZT+3TC, infant received 6 weeks of AZT or NVP, no extended breastfeeding
prophylaxis

Option B recommends AZT+3TC at 14 weeks for mother diagnosed to be HIV positive, a triple
ARV treatment until one week after end of breastfeeding for use as prophylaxis to prevent
mother-to-child transmission of HIV.

Attaining success across all four prongs of PMTCT will be required to effectively scale up
programs to eliminate MTCT.

This assertion by the WHO is a critical contribution to our effort to optimize our efficiency in
delivery of services to virtually eliminate MTCT

OPTION B PLUS FOR EMTCT

To Eliminate Mother To Child Transmission (EMTCT) Of HIV By 2015 the World Health
Organization (WHO) asserted, “Options B and specifically B+ are likely to prove preferable to
Option A for operational, programmatic and strategic reasons” in their Programmatic Update on
the Use of Antiretroviral Drugs for Treating Pregnant Women and Preventing HIV Infections in
Infants.
Under Option B+, all pregnant women diagnosed with HIV are offered lifelong ART
( a triple therapy TDF/3TC/EFV for pregnant women or TDF/3TC/NVP if the mother cannot
stand the toxicities of Efavirenz) plus cotrimoxazole prophlaxis at 14 weeks gestation,
irrespective of their CD4 count and infant prophylaxis is recommended for 6 weeks (NVP), then
do PCR at 6weeks encourage exclusive breastfeeding for 6months continue to breastfeed their
babies for one year and the baby is tested again if positive then the baby is started on ARVs
NVP can be given to mothers who cannot tolerate the toxicities of EFV.
Option B+ has additional benefits over both Options A and B

 Lowered transmission to infants

 Improved maternal health.

 Lowered transmission to HIV-negative male sexual partners

Note: Remind yourselves on general HIV management and PEP