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What to do incase of Hiv In Pregnancy?


Medical Treatment:
  • Perform a baseline ALT and creatinine concentration before starting ART.
  • Women with abnormal ALT should not start nevirapine.
  • Tenofovir is contra-indicated in women with a calculated creatinine clearance or eGFR of <60 mL/minute
  • In concurrent TB, use efavirenz in place of nevirapine after first trimester.
Criteria for lifelong ART initiated during pregnancy: WHO stage 3 or 4 disease OR CD4 < 350 cells/mm3
CD4 < 250 cells/mm3:

  • Tenofovir, oral, 300 mg daily.
AND
  • Lamivudine, oral, 150 mg 12 hourly or 300 mg at night.
AND
  • Nevirapine, oral, 200 mg daily for two weeks, followed by 200mg 12 hourly.
CD4 equal to or greater than 250 cells/mm3, only start after the first trimester:
  • Tenofovir, oral, 300 mg daily.
AND
  • Lamivudine, oral, 150 mg 12 hourly or 300 mg at night.
AND
  • Efavirenz, oral, 600 mg at night.
As attaining an undetectable viral load is important in PMTCT, special attention should be paid to adherence monitoring.
Note:
  • Women who conceived on efavirenz-based ART and present at or beyond 14 weeks gestation, should continue with their treatment regimen and, where possible, be referred to a tertiary centre for a fetal anomaly ultrasound scan at 18-22 weeks.
CD4 equal to or greater than 350 cells/ mm3 and WHO stage 1 or 2 disease
From 14 weeks gestation onwards until the onset of labour:
  • Zidovudine, oral, 300mg 12 hourly,
AND
At the onset of labour:
  • Nevirapine, oral, 200mg immediately as a single dose
PLUS
  • Tenofovir 300mg and emtricitabine 200mg oral, as a single dose
AND
  • Zidovudine, oral, 300mg intrapartum every 3 hours until birth
Do a baseline haemoglobin (Hb) antenatally before starting zidovudine and monitor Hb every 4 weeks. If Hb < 8 g/dL, correct the anaemia before reintroducing zidovudine.
Women scheduled for elective Caesarean section:
  • Antenatal zidovudine as above
AND
4 hours before surgery:
  • Nevirapine, oral, 200 mg as a single dose.
AND
Within a day following Caesarean section:
  • Tenofovir 300mg and emtricitabine 200 mg, oral.
  • Combination antiretroviral therapy (ART) consists of three or more antiretroviral drugs that are capable of suppreBetaing HIV replication when used together.
  • The usual ART regimen contains two nucleoside reverse transcriptase inhibitors (NRTIs) together with either a non-nucleoside reverse transcriptase inhibitor (NNRTIs) or a protease inhibitor.
  • High levels of adherence are essential for long-term succeBeta with ART.
ELIGIBILITY FOR ART
Eligible to Start ART
  • CD4 count < 350 cells/mm3 irrespective of clinical stage
OR
  • Pregnant women WHO stage III irrespective of CD4 count
OR
  • WHO stage IV (excluding TB) irrespective of CD4 count
OR
  • MDR/XDR-TB irrespective of CD4 count
Require fast-track (i.e. ART initiation within 2 weeks of being eligible)
  • Pregnant women eligible for lifelong ART
OR
  • Patients with very low CD4 (<100 cells/mm3)
OR
  • Stage 4, CD4 count not yet available
OR
  • MDR/XDR TB.