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PMTCT
1. Tindakan pencegahan primer terhadap HIV
2. Pencegahan terhadap kehamilan yang tidak direncanakan pada ibu terinfeksi HIV
3. Pencegahan transmisi HIV dari ibu ke bayi yang dikandungnya
4. Perawatan, dukungan dan pengobatan bagi ibu, anak dan keluarga yang terinfeksi HIV
Risiko penularan HIV dari ibu ke bayi
tanpa intervensi PMTCT
Periode transmisi Risiko
•kehamilan 5-10%
•persalinan 10-20%
•menyusui 10-15%
Total 25-45%
KEHAMILAN:
Penatalaksanaan Antenatal
• Asuhan antenatal seperti biasa
• Kurangi kadar virus (viral load)
– Ibu minum ARV
ARV TERAPI ARV PROFILAKSIS
TUJUAN MENCEGAH TIMBULNYA AIDS
MENCEGAH PENULARAN HIV DARI IBU KE BAYI
PENGGUNAAN JANGKA LAMA MASA KEHAMILAN
KELAYAKAN PEMBERIAN KLINIS DAN KADAR CD4 IBU HIV YANG HAMIL
PERSALINAN:
penatalaksanaaan
• Seksio sesarea elektif– Risiko transmisi terkecil– Mengurangi risiko penularan HIV ke bayi
50-60%
• Persalinan pervaginam– Risiko transmisi meningkat bila terjadi
proses persalinan (inpartu) dan ketuban pecah dini
MENYUSUI
REKOMENDASI TENTANG NUTRISI BAYI
BAYI DARI IBU HIV
• ASI : makanan terbaik
• Risiko penularan HIV melalui ASI sekitar 15-20%
• Risiko diperbesar dengan adanya lecet payudara (menjadi 63%)
Rekomendasi tentang nutrisi bayi
• Apabila Ibu memilih untuk memberikan ASI, dianjurkan ASI eksklusif selama 6 bulan
• Sangat tidak dianjurkan untuk menyusui campur (mix feeding)
• Setelah 6 bulan, bayi diberi PASI dan ASI di stop
Rekomendasi tentang nutrisi bayi
• Apabila ibu memilih memberikan susu formula Eksklusif maka harus memenuhi persyaratan AFASS:
– Acceptable
– Feasible
– Affordable
– Sustainable
– Safe
Cumulative probability of HIV among 549 children born toHIV+ women
0
5
10
15
20
25
30
35
40
45
ASI eksklusif
Mix-feeding
Susu formula
AIDS 2001, 15:379-87
Rekomendasi tentang nutrisi bayi
• Apabila ibu memilih memberikan susu formula Eksklusif maka harus memenuhi persyaratan AFASS:
– Acceptable
– Feasible
– Affordable
– Sustainable
– Safe
Drug Dose
Zidovudine
- Gestational age > 35 weeks 2 mg per kg body weight per dose given orally started as close to birth as possible (by 6-12 hours of delivery), then every 6 hours
- Gestational age 30-35 weeks2 mg per kg body weight per dose given orally every 12 hours, advanced to every 8 hours at 2 weeks of age
- Gestational age < 30 weeks 2 mg per kg body weight per dose given orally every 12 hours, advanced to every 8 hours at 4 weeks of age
Nevirapine 2 mg per kg body weight given orally as single dose, between birth and 72 hours of age.
ARV for baby
Perinatal HIV Guidelines Working Group, 2008
MotherAntepartumIntrapartumPostpartum
AZT starting at 28 weeks of pregnancy or as soon as feasible Sd-NVPb + AZT/3TCAZT/3TC × 7 days
Infant Infant Sd-NVP + AZT × 7 days*
WHO recommendation
* If the mother receives less than four weeks of AZT during pregnancy, four weeks instead of one week of AZT is recommended
Recommended prophylactic ARV regimens for pregnant women who are not yet eligible for ART
US recommendation: AZT for 6 weeks
Perinatal HIV Guidelines Working Group, 2008
WHO, 2006
• Single dose nevirapine + zidovudine for 6 weeks
Cipto Mangunkusumo Hospital protocol (2007)
PHPT-2 protocol modification (Thai, 2004), formula feeding N Eng J Med. 2004;351:229-40
Vaccine WHO/UNICEF ACIP
Asymptomatic Symptomatic HIV +
BCG Yes (birth) No No
DPT Yes ( 6,10,14
weeks)
Yes Yes (acellular P)
Oral Polio Yes (0,6,10,14
weeks)
Yes No (IPV)
Measles Yes (6 & 9
months)
Yes Yes, if CD4>15%
Hepatitis B Yes Yes Yes
Pneumococcus - - Yes
Hib - - Yes
Meningococcus - - Yes
Influenza - - Yes, age > 6 mos
Varicella - - Yes
Yellow Fever Yes - Yes
Immunizations recommendations
Lancet Infect Dis 2004
Jadwal kunjungan PMTCTSaat
lahir
10 hr 4
mgg
6
mgg
2 bln 3 bln 4 bln 6 bln 9 bln 18 bln
BB/PB
Nutrisi SF SF SF SF SF SF SF SF-MP SF-MP SF-MP
ARV profilaksis
(sdNVP 2mg/kg;
AZT 2mg/kg/x,
4x/hari**
Kotrimoksazol
Imunisasi Imunisasi sesuai jadwal IDAI/Depkes
Perhatian khusus: BCG
Hb/Ht
PCR RNA/DNAAB
Keterangan: BB = Berat Badan PB = Panjang Badan SF = Susu Formula MP = Makanan Padat
Hb = Hemoglobin HT = Hematokrit PCR RNA/DNA = Polymerase chain reaction RNA/DNA AB = antibodi HIVARV: antiretroviral, sdNVP: single dose nevirapin, AZT: zidovudin, **: dosis khusus untuk prematur