- March 11, 2016
- Posted by: emobile
- Category: Patient's Corner
Emobileclinic Patient’s corner
The HIV/AIDS pandemic is one of the most serious health crisis the world is facing today and no doubt, is still a global concern. A disproportionate burden has been placed on a woman and children, who in many settings continue to experience high rates of new HIV infections and HIV related illness and death.
The greatest burden of HIV and AIDS epidemic has been in sub-“Saharan Africa, with approximately 67.6% of the total number of people living with HIV. Over the decades, the epidemic once dominated by infected males has become progressively feminized and in Sub-Saharan Africa approximately 60% of adult living with HIV are women while 90% of infection in children is acquired through mother to child transmission (MTCT) and as more women contract the virus, the number of children infected has been growing.
Most children less than 15years living with HIV acquired the infection through MTCT. This can occur during pregnancy, labour and delivery or during Breastfeeding. In the absence of intervention the risk of such transmission is 30-45%. The rate of MTCT of HIV is affected by many factors. These include high maternal viral load, advanced maternal disease, maternal immune deficiency, HIV infection acquired during pregnancy or Breastfeeding, STIs, malaria, prolonged Labour, rupture of membranes for more than 4 hours, vaginal delivery, prematurity,1st of multiple deliveries, mixed feeding, breast disease such as abscess, cracked nipples and prolonged breast feeding.
The risk of MTCT can be reduced to less than 2% by interventions that include the use of anti-retrovirals (ARVs) as either prophylaxis or therapy given to women in pregnancy, labour and Breastfeeding. In a situation where a mother is not receiving ARVs during breastfeeding period, the breast-fed infant should receive ARVs prophylaxis until one week after cessation of all breastfeeding. Where breast feeding is not possible however, the use of commercial infant formula becomes an alternative.
Other important preventive measures include avoiding obstetrics procedures such as chronic villus sampling, external cephalic version, early artificial rupture of membrane, instrumental delivery and episiotomy where possible, as well as active management of the third stage of labour and the use of elective cesarean delivery
HIV testing of pregnant women attending antenatal care serves as an entry point for PMTCT services. In all settings, HIV testing and counseling is recommended for all pregnant women irrespective of presence or absence of high risk behaviors or local prevalence of HIV in the community. Mandatory testing is however not recommended. The laboratory testing of diagnosis of HIV infection is either by detection of viral particles or its components or by indirect methods of detecting antibodies against the virus.
Pregnancy in the HIV positive women is an indication for ARVs irrespective of CD4, viral load or clinical setting. Available data shows that maternal use of ARVs in HIV positive women during pregnancy and continued during Breastfeeding is the most effective intervention for maternal health and is effective in reducing MTCT. ART is initiated in HIV positive pregnant women whose CD4 count is < 350 cells/ml irrespective of WHO clinical staging. HIV infection on its own is not an indicated cesarean section. Available evidence shows that elective caesarean section (ELCS) for women on ART with low viral load (<1000 copies/ml) has no added advantage over vaginal delivery. ELCS should only be offered to HIV positive women before the onset of labour or rupture of membrane especially in the absence of ART or where the maternal viral is load high. Evidences show that when ELCS is performed before the onset of labour or rupture of membranes, it reduces risk of MTCT by greater than 50% as compared to vaginal delivery. Prophylactic antibiotics is also recommended where caesarean section is performed (elective or emergency) in HIV positive women. Longer courses of antibiotics should be considered if caesarean section is performed after prolonged labour or prolonged rupture of membranes.
Exclusive breast feeding is recommended for all HIV infected mothers during the first 6 months after delivery, after which complementary feeds are introduced and breast feeding continued up to 12 months. Early cessation of breast feeding before 6 months and abrupt cessation are no longer recommended as stoppage can be gradual. However Breastfeeding should be accompanied with maternal ART or ARV prophylaxis and/or infant ARV prophylaxis for up to 1 week after stopping breast feeding.