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Perinatal HIV &Prevention of Parent to Child Transmission (PPTCT) in India
DR. Yusuf ImranMDJ.N Medical College, AMUAligarh, India
Treatment
Perinatal HIV (NACO Guidelines- Dec 2013
In the absence of any intervention the risk of perinatal transmission is 15-30% in non-breastfeeding populations.
Breastfeeding by an infected mother increases the risk by 5-20% to a total of 20-45%. Transmission can be reduced to under 2% by interventions (ARV prophylaxis to mother and
neonate-elective cesarian-complete avoidance of breastfeeding). However, in view of emerging evidence national guidelines recommend cesarian section only for
obstetric indications. All instrumentation (forceps/vaccum/episiotomy/artificial rupture of membranes/PV etc.) should
be avoided during labor and suctioning is done only for meconium stained babies.
Treatment
Perinatal HIV (NACO Guidelines- Dec 2013
ARV regime for pregnant women
o All pregnant women detected positive for HIV during any trimester of pregnancy or lactation should be started on lifelong ART irrespective of disease stage or CD4 counts.
o Preferred regimen- Tenofovir 300mg + Lamivudine 300mg + Efavirenz 600mgo Alternate regimens- Azathioprine+lamivudine+Efavirenz, Azathioprine+Lamivudine+Nevirapine,
Tenofovir+lamivudine+Nevirapine.o Pregnant women already on ART should continue lifelong on whatever regimen they are
stabilised on.
Treatment
Perinatal HIV (NACO Guidelines- Dec 2013
ARV regime for infants born to HIV+ mothers
o If mother received ART adequately in the antenatal period- Daily Nevirapine prophylaxis for 6 weeks.
o If mother has not received ART or Received ART for less than 24 weeks- Daily Nevirapine prophylaxis for 12 weeks.
Dose and duration of Nevirapine prophylaxis (HIV-1 infection)* Give first dose of NVP within 6-12 hours of delivery
Treatment
Perinatal HIV (NACO Guidelines- Dec 2013
Breastfeeding
o Factors that increase likelihood of transmission include detectable levels of HIV in breast milk, mastitis, low maternal CD4 count.
o Start mother on ART (if not started earlier), as this reduces chances of transmission through breastfeeding.
o According to updated PPTCT guidelines (NACO) in India, infants should be given exclusive breastfeeding for the first 6 months followed by complementary feeding.
o Support breastfeeding for a minimum of 6 months and continue breast feeding in addition to complementary feeds for 1 year. At 1 yr stop breastfeeding gradually within 1 month.
Treatment
Perinatal HIV (NACO Guidelines- Dec 2013
Breastfeeding cont…
o Exclusive replacement feeds may be started if mother has died or has terminal illness or decides not to breastfeed despite adequate counselling.
o In such case commercial formula milk is given when AFASS (Affordable, Feasible, Sustainable and Safe) criteria is met.
o Mixed feeding (breastfeeding + replacement feeds) should not be given in the first 6 months.
Treatment
Perinatal HIV (NACO Guidelines- Dec 2013
Postnatal Diagnosis of HIV Infection
Flowchart on next slide…
Not detected
Treatment
Perinatal HIV (NACO Guidelines- Dec 2013
Cotrimoxazole prophylaxis
o It is recommended for all HIV exposed children under age 18 months starting at 4-6 weeks of age and continued until HIV infection can be excluded.
o Cotrimox prophylaxis is also recommended for breastfeeding child of any age until HIV infection can be excluded (by testing after >6 weeks of stopping breastfeeding).
o In children of less than 6 months dose is 2.5 ml once a day (Syrup trimethoprim 40 mg and sulphamethoxazole 200mg/5ml).
Treatment
Perinatal HIV (NACO Guidelines- Dec 2013
Immunization
o HIV exposed or infected but asymptomatic children should receive all standard vaccines as per national schedule.
o HIV infected children with immune suppression or symptoms should receive all standard vaccines except BCG, OPV and Varicella vaccines.
o Consider HiB and Pneumococcal vaccines in all HIV exposed children irrespective of symptoms or CD4 count.
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