Prevention of Parent to Child Transmission of HIV (PPTCT)

Prevention of Parent to Child Transmission of HIV (PPTCT)

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  -Kranthi Chiluka
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  Total number ofChildren Living with HIV/AIDS In INDIA 10,00,000
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  9,50,000 (95%) Occur Due To VerticalTransmission From Infected Parents All These Cases CAN BE PREVENTED By Taking Adequate Measures
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  VERTICAL TRANSMISSION OFHIV-1 It is an important and unique aspect of pediatric AIDS. In developing countries 95% of cases in children occur due to vertical transmission from their infected parents. Potential routes of infection include : 1. Admixture of maternal fetal blood 2. Infection across the placenta antenatally 3. Extensive mucocutaneous exposure to maternal blood and vaginal secretions intranatally.
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   High viralload in the maternal circulation  Maternal seroconversion just before delivery  Vitamin A deficiency in mother  > 4-hr duration of rupture of membrane  Vaginal delivery  STD in mother Factors which may increase rate of vertical transmission of HIV-1 are:
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   Delivery before34 weeks  Birth weight < 2.5 kg  Detectable p24 antigen in maternal serum  Absence of neutralizing antibodies in maternal serum  Maternal CD4+ count less than 700/cumm or CD4+/CD8+ ratio less than 0.6.
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  BREAST MILK ACQUIREDHIV-I INFECTION However WHO advocates breastfeeding in view of high mortality related to - Diarrhea - Malnutrition and - Respiratory Disease 1. Virus load in the breast milk and 2. Length of time the child is fed. Transmission through breastfeeding seems to be related to the Needs to be decided on individual merit depending on hygiene and socio-economic factors.
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  When a pregnantwomen presents during pregnancy, she should be given ART as follows (to prevent MTCT): 1. Antepartum: Oral AZT 300 mg BD from 28 weeks gestation or as soon as feasible. 2. Intrapartum: AZT continued as 300 mg at onset of labor and 300 mg every 3 hrly till labor. Also 3TC 150 mg every 12 hrly till labor Also single dose NVP 200 mg at onset of labor 3. Postpartum: Oral AZT 300 mg BD and 3TC 150 mg BD for 7 days. For the baby: NVP single dose 2 mg/kg within 72 hours of birth and oral AZT 2 mg/kg 4 times a day for 7 days. Azidothymidine (AZT) Lamivudine (3TC) Nevirapine (NVP)
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  By: Kranthi Chiluka Guntur MedicalCollege Guntur, Andhra Pradesh India For Info: Write to [email protected]