Preventing Mother to Child Transmission (PMTCT) of HIV ...



DRAFT

Preventing Mother To Child Transmission (PMTCT) of HIV Infection

A practical guide to the management of the HIV positive pregnant woman and her infant

Also incorporating management of HBV, HCV and syphilis exposed infants

This document serves as a guideline for management.

Ultimately each pregnancy calls for an individualised care plan.

Table of Contents

Snapshot of changes to 2011 guidelines….……………………………………2

Background 3

General Considerations 3

Confidentiality 3

Infection Control 3

Care of the pregnant woman 4

Antenatal care 4

The HIV test 4

Response to the test 4

Risk factors for Vertical Transmission of HIV 6

Antiretroviral therapy for HIV +ve pregnant women 8

Labour and Delivery ..10

Post Partum ………………………………………………………………………12

Neonatal Care 13

Infant post exposure prophylaxis 13

Infant Monitoring 14

Management of the exposed infant 16

Maternal refusal of recommendations ……………………………………….. 18

CONTACTS 19

Appendices

1. Management of HIV in Pregnancy

2. Instructions for the administration of IV zidovudine to the mother

3. Instructions for the administration of IV zidovudine to the neonate

4. Monitoring of infants exposed to HIV

5. Guidelines for the use of PCP/PJP prophylaxis

6. Immunisation schedule of infants exposed to HIV

7. Guidelines for the management of Hepatitis B exposed infants

8. Monitoring of infants born to women with hepatitis B and/or C virus

9. Syphilis Algorithm

10. Prescribing information zidovudine (ZDV, AZT, Retrovir)

11. Prescribing information lamivudine (3TC, Epivir)

12. Prescribing information Nevirapine (Viramune)

13. Paediatric Developmental Assessment Checklist

Acknowledgements:

The staff of the Rainbow Clinic would like to thank everyone who contributed to the development and review of this document, in particular Dr Fiona Lyons SJH and colleagues in the adult HIV and obstetric services.

Snapshot of Changes to PMTCT HIV Guidelines 2011

Antenatal

Late Bookers (ie. after fetal viability): please request URGENT HIV testing and organise a quick turn around with the relevant testing facility. Results should be available within 2 working days.

Women refusing AN testing: Strong recommendation to test the baby ASAP after birth. Results should be available within 48 hours of birth to facilitate urgent commencement of neonatal post exposure prophylaxis if needed.

Starting ARV’s in pregnancy

There has been a move towards earlier initiation of ARV’s to ≤20/40 gestation to maximise the reduction of mother-to-child transmission (MTCT) risk

Changing ARV’s

In general, for women stable on ARV’s, conception is not an indication to change treatment choice.

Intra-Partum

Peripartum IV zidovudine still recommended for women unless:

• Maternal ARV’s for > 4 weeks with an HIV viral load at 36 weeks of ................
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