HIV MOTHER-TO-CHILD-

TRANSMISSION DINA MAKLAD

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• Placenta• 5 to 10%

• cervical secretions or blood

• 10 to 20%

• breast milk (or blood)

• 10 to 20%

Approximately 8,500 women living with HIV give birth annually

Living with HIV

DEATH

An estimated 4,998 children ever diagnosed with AIDS have died since the beginning of the epidemic through the end of 2013 (includes only those under age 13 at time of death).

 Almost all of them (91%) got HIV through perinatal transmission

UNICEF GLOBAL PLAN FOR 2015About 220,000 new HIV infections occurred in 2014, dramatically declining from 400,000 in 2009.Progress in reducing has been dramatic since the introduction in 2011 of the ‘Global Plan towards the Elimination of New HIV Infections among Children

UNICEF GLOBAL PLAN FOR 2015

PREVENTION Currently, no vaccine is available for HIV; therefore, prevention is crucial to decreasing

the risk of transmission. Women must be counseled on methods to avoid transmission

• Take HIV medicines (ART) for their own health if they think they might want to become pregnant.

• When pregnant, take HIV medicines the right way every day throughout the pregnancy, labor, and delivery.

• Delivery by caesarean section.• Vaginal under certain precautions. • After delivery, ensure their infants take HIV medicines.• Avoid breastfeeding.• Avoid pre-chewing food for an infant, toddler, or anyone else.

received antiretroviral medication in the past but is not currently on any medication

( the indication for stopping treatment in the past / gestational age/ resistance testing) Antiretroviral medication

Antiretroviral therapy• all pregnant women infected with HIV to reduce the risk of

perinatal transmission to below 2%.• Combination antiretroviral therapy should be offered in all

cases.• zidovudine (ZDV )as part of the highly active antiretroviral

therapy (HAART) regimen.

In an HIV-infected pregnant woman who has never been exposed to antiretroviral medication HAART as soon as possible , including during the first trimester

Note Recommendations are for drug-resistance testing and care to avoid

medications that may potentially cause adverse maternal and fetal effects.

On a HAART regimen presents for prenatal care continuing treatment during the first trimester

• HIV antiretroviral drug resistance testing is recommended if a viral load is detectable.

PREVENTION CHALLENGES

1. Pregnant women with HIV may not know they are infected

2. Many HIV medical care providers don’t routinely offer pregnancy tests, preconception care,

family planning services, or prenatal care for women with HIV. 

3. The risk of perinatal HIV transmission is much higher if the mother’s antiretroviral HIV

treatment is interrupted at any time during pregnancy, labor, or delivery, or if HIV medicines

are not provided to her infant. 

4. Social and economic factors.

World Health Organization PMTCT guidelines, In September 2015

• Guidelines for pregnant and breastfeeding women living with HIV

• Option B+ where lifelong ART is provided to all pregnant and

breastfeeding women living with HIV regardless of CD4 count or WHO

clinical stage

• ART should be maintained after delivery and completion of

breastfeeding for life

Guidelines for HIV-exposed infants• All infants born to HIV-positive mothers should receive a course of

treatment as soon as possible after birth.

• The treatment should be linked to the ARV drug regimen that the

mother is taking and the infant feeding method.

Breastfeeding - the infant should receive once-daily nevirapine (NVP) from birth for six weeks.

Replacement feeding - the infant should receive once-daily NVP (or twice-daily zidovudine (AZT)) from birth for four to six weeks

NOTE:At four to six weeks old, all infants who are born to HIV-positive mothers should be given an early infant diagnosis. Another HIV test should be done at 18 months and/or when breastfeeding ends to provide the final infant diagnosis.

Thank You!