विवरण
Early and routine HIV testing during pregnancy is essential for timely diagnosis. Antiretroviral therapy (ART) reduces transmission risk, protecting the fetus. Regular monitoring ensures optimal immune health for both mother and child. Tailored ART regimens consider viral load, CD4 count, and maternal health. Scheduled cesarean section may be recommended to minimize transmission risks during childbirth. Administering antiretroviral drugs to newborns further reduces the risk of transmission during breastfeeding. Continuous medical surveillance monitors both maternal and infant health. Addressing stigma and providing counseling supports the emotional well-being of pregnant individuals with HIV. Educating patients on adherence, contraception, and the importance of medical follow-ups is crucial for successful management.
सारांश
- HIV is an RNA virus with two main types, HIV-1 and HIV-2, each having subtypes. Its structure, including reverse transcriptase, integrase, protease, and core proteins like P24, is essential for understanding drug targets. Transmission primarily occurs through sexual contact, IV drug use, and vertical transmission, though blood transmission is now rare due to screening.
- Diagnosis relies on Elisa, PCR, and Western blot tests, differentiating between HIV-1 and HIV-2 for appropriate treatment. False positives in Elisa tests can result from various factors, including HLA antibodies and recent flu immunizations. False negatives mainly occur during the window period of recent infection.
- Preconception counseling involves voluntary serological testing. For serodiscordant couples, ART for the HIV-positive partner with an undetectable viral load minimizes transmission risk. Screening for genital tract infections and infertility is crucial, with IUI as an option for HIV-positive women with negative partners.
- Managing HIV in pregnant women includes monitoring CD4 cell counts every trimester and assessing viral load initially, after starting ART, and regularly thereafter. Side effects of ART should be monitored with CBC, BU, creatinine, and liver function tests. Screening for gestational diabetes, viral hepatitis, TB, toxoplasmosis, CMV, and STDs like syphilis is also vital.
- Treatment goals include suppressing plasma HIV RNA, restoring immunological function, reducing morbidity, prolonging survival, and preventing vertical transmission. Management scenarios depend on when HIV is detected, guiding the use of ART and CD4 testing. The triple treatment regimen commonly used in pregnancy consists of tenofovir, faviranze, and laming wooden.
- Delivery methods depend on viral load. Scheduled cesarean delivery at 38 weeks is recommended if the viral load is high, while vaginal delivery is an option with suppressed viral load. Safer delivery techniques, including avoiding prolonged rupture of membranes, repeated vaginal exams, instrumental delivery, and routine episiotomy, minimize transmission risk.
- Postnatal infant care involves nevirapine prophylaxis, with duration dependent on maternal ART adherence. HIV testing for infants is conducted at 6 weeks, 6 months, and 12 months, with final diagnosis at 18 months. Women are advised to use dual contraception, including intrauterine copper tea and condoms, with birth spacing of 2-3 years.
- Active TB increases HIV transmission. HIV-infected pregnant women with active TB should start ART irrespective of CD4 count. Efavirenz is generally a preferred NNRTI in this case. Counsel mothers that ART is a lifelong commitment and that family members should be involved to support them.
नमूना प्रमाण पत्र
वक्ताओं के बारे में
Dr Maitrayee Chennu
Consultant Obstetrician and Gynaecologist Sankhya Hospitals, Hyderabad
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