HIV
IN
PREGNANCY
INTRODUCTION
HIV (Human Immunodeficiency Virus) is a
virus that causes AIDS (Acquired
Immunodeficiency Syndrome)
.A person may be "HIV positive" but not have AIDS.
• An AIDS infected person cannot fight off diseases
as they would normally and are more susceptible
to infections, certain cancers and other health
problems that can be life-threatening or fatal.
HIV (Human Immunodeficiency Virus) during
pregnancy poses significant challenges for both
the mother and the unborn child. It requires
careful management to prevent transmission to
the infant and ensure the well-being of both
mother and child.
HIV Transmission
Through blood or blood From an infected mother to her
Through unprotected
products, donated semen or child (vertical/perinatal
sexual intercourse. transmission).
organs.
HOMOSEXUAL HETEROSEXUAL
Factors affecting Mother-To-Child Transmission
Viral genotype and phenotype
VIRAL Viral resistance
Viral load
Maternal immunological status
MATERNAL
Maternal nutritional status
Maternal clinical status
Behavioural factors
Antiretroviral Treatment
Prolonged rupture of membranes (4 hours)
Mode of delivery
OBSTETRICAL Intrapartum haemorrhage
Obstetrical procedures
Invasive fetal monitoring
Prematurity
FETAL Genetic
Multiple pregnancy
Breastfeeding
INFANT Gastrointestinal tract factors
Immature immune system
• At the end of 1998, more than thirty-three million people were living with
the human immunodeficiency virus (HIV), almost half of whom were women
in their reproductive years.
Over one million children are living with HIV, contracted predominantly
through infection from their mothers.
• There is an estimated one and a half million HIV- positive women becoming
pregnant each year, almost 600 000 children will be infected by mother-to-
child transmission annually: over 1600 each day
• Most form common • The clinical course of HIV- 2 disease is slower than
• Prevalence is HIV-1
that of HIV-1.
increasing
HIV I
• Dual infection with HIV-1 and HIV-2 is possible,
although it has been suggested that HIV-2 infection
may confer some protection against HIV-1
acquisition.
• Found predominantly
in West Africa
•Prevalence has HIV-2
remained fairly stable • Although mother-to-child transmission of HIV-2
HIV II has been documented, this occurs less frequently
than with HIV-1.
HIV AND PREGNACY:
• In most cases, HIV will not cross through the placenta from
mother to baby. If the mother is healthy in all other aspects, the
placenta helps provide protection for the developing infant.
• Unless a complication should arise, there is no need to increase
the number of prenatal visits. As such, health care providers
should watch for symptoms of AIDS and pregnancy-related
complications of HIV infection.
CAUSES
HIV in pregnancy is primarily caused by
the transmission of the virus from an
infected mother to her baby during
pregnancy, childbirth, or breastfeeding.
Without proper interventions, the risk of
transmission can be as high as 15-45%.
Affects of HIV Infections Ectopic Pregnancy
on Pregnancy
Preterm Labour
(Abruptio Placentae
Low Birth Weight Complications
& Rupture of
Membrane)
Still Births
Spontaneous Abortion (usuallay assc.
with ifx)
PHARMACOLOGIC
MANAGEMENT
Pharmacologic management of HIV in pregnancy focuses
on antiretroviral therapy (ART) to suppress the viral load in
the mother, reducing the risk of transmission to the fetus.
ART regimens are carefully chosen based on factors such
as maternal health, stage of pregnancy, and viral
resistance profiles. These medications are generally safe
for use during pregnancy and have been shown to
significantly reduce the risk of transmission to less than 1%.
Antiretroviral Therapy:
• The use of antiretroviral drugs in pregnancy should be considered for
two indications: the health of the mother and prevention of
transmission. Pregnancy should not be a contra- indication for
antiretroviral therapy in the mother, if indicated.
MEDICAL
MANAGEMENT
Medical management of HIV in pregnancy involves
close monitoring of both maternal and fetal health
throughout pregnancy. This includes regular obstetric
visits, monitoring of viral load, CD4 count, and
screening for opportunistic infections. Obstetric
interventions, such as elective cesarean section, may
be recommended in certain cases to further reduce
the risk of transmission during childbirth.
Medical Treatment During Pregnancy:
• If treatment for opportunistic infections is necessary, it should be used in pregnancy,
depending on the clinical stage of the patient. Treatment regimens should follow local
policy guidelines and where a variety of treatment options are available, those with the
lowest risk to the fetus should be used.
Dermatological conditions are common in HIV positive women and men, and treatment
may be required for prolonged periods. Acyclovir can be used safely after the first trimester.
Topical imidazole antifungals or topical gentian violet can be used throughout pregnancy
and oral fl after the first trimester if
NURSING
MANAGEMENT
Nursing management plays a crucial role in
supporting pregnant women living with HIV. This
includes providing education and counseling on the
importance of ART adherence, promoting healthy
behaviors to minimize the risk of transmission, and
addressing any concerns or misconceptions the
mother may have. Nurses also play a key role in
facilitating communication between the healthcare
team and the patient, ensuring comprehensive care
throughout pregnancy and beyond.
Care During Labour and Delivery:
• Care during labour for HIV positive women should follow
routine practice in most respects.
Prolonged rupture of membranes should be avoided, as
mother-to-child transmission is increased where
membranes are ruptured for more than four hours. Artificial
rupture of membranes should not be undertaken if progress
of labour is adequate.
Episiotomy should not be performed routinely, but reserved
for those cases with an obstetrical indication.
If an assisted delivery is required, forceps may be preferable to vacuum extraction,
given the risk of micro-lacerations of the scalp from the vacuum cup.
• There is increasing evidence that elective caesarean section may help prevent
transmission of HIV to the baby.
The operation carries risks of maternal complications and is associated with higher
post operative morbidity in HIV positive women.
Prophylactic antibiotics should be given for both elective and emergency caesarean
sections.
DIAGNOSTIC
MANAGEMENT
Diagnostic procedures for HIV in
pregnancy typically involve routine
screening for all pregnant women during
their prenatal care visits. This screening
involves blood tests to detect the
presence of HIV antibodies or the virus
itself. Early detection is crucial for
implementing interventions to prevent
mother-to-child transmission.
• HIV positive women should have a full physical examination at the first visit.
Particular attention should be paid to any signs of HIV-related infections.
"Clinical diagnosis and treatment of vaginal or cervical inflammation, abnormal
discharge or STD should be a priority."
• The pregnant woman should be monitored for any signs of HIV-related
opportunistic infections and for any other intercurrent infections, such as urinary
or respiratory infection.
• Maternal weight should be monitored and nutritional
supplementation advised where necessary.
• The oro-pharynx should be examined at each visit, for the presence
of thrush.
•Syphilis testing should be undertaken, and repeat testing in late
pregnancy may be advisable.
• A Hemoglobin estimation is mandatory and a complete blood count
should be performed and T cell subset investigations undertaken
where possible.
• Anemia is more common in HIV-infected women and repeated
hemoglobin tests may be helpful.
• Viral load estimation may provide a valuable prognostic indicator, where
available.
• A cervical smear should be performed if this has not been undertaken within the
recent past. Colposcopy should be reserved for women who have an abnormal
cervical smear result.
PREVENTION
Many women living with HIV have given birth to HIV negative children
by taking these precautions:
Taking anti-HIV drugs during pregnancy.
Making a careful choice between caesarean section and vaginal
delivery.
Not breastfeeding.
Giving the new baby an anti-HIV drug for a few weeks.
By doing these things, the chances of the baby having HIV become
very low – under 1%. If you're on HIV treatment and have an
undetectable viral load, the chances are lower still: 0.1%.
F.A.Q’s about HIV and Pregnancy
What should you avoid if you are HIV positive?
Do not eat or drink the following foods:
Raw eggs or foods that contain raw eggs, for example, homemade cookie dough.
Raw or undercooked poultry, meat, and seafood.
Unpasteurized milk or dairy products and fruit juices.
How does HIV affect everyday life?
Having HIV can be a source of major stress. HIV may challenge
your sense of well-being or complicate existing mental health
conditions. HIV, and some opportunistic infections, can also
affect your nervous system and can lead to changes in your
behavior.
After my baby is born, will he or she have
to take HIV medications?
When a pregnant woman with HIV takes effective ART (HIV medications)
during her pregnancy, the chances of her baby getting HIV are extremely
low. To reduce the risk even more, it is recommended that all infants who
are born to mothers with HIV take medications for a short time. If you took
ART during your pregnancy and had an undetectable viral load, your baby
will receive liquid zidovudine (AZT, Retrovir®) for 4-6 weeks. If you didn't
have an undetectable viral load during pregnancy, your baby may need
medicine for a longer period of time.
Why can't I breastfeed my baby?
Many mothers look forward to breastfeeding their
babies. However HIV can be passed through breast milk.
If you breastfeed your child, you run the risk of your baby
getting HIV.
It is recommended that mothers with HIV do not
breastfeed their babies and that they use formula
instead. If you would like more information on the
possible risks and benefits of breastfeeding, consult with
a pediatrician or obstetrician who is an expert in HIV
infection, ideally before delivery.
THANK YOU
https://www.ncbi.nlm.nih.gov/books/NBK558972/
https://www.womenshealth.gov/hiv-and-aids/living-hiv/pregnancy-and-hiv
GROUP 1
DENOSTA, CHRISTIAN B
DEQUILLA, MARCUS RELLEY
BROWN, KARL KEVIN
PERUELO, SYDWYN DALE
VALENCIA, JOHN ALRICH
VALENZUELA, JEFFERSON
