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HIV Maternal to Child

Transmissions

Syed Mohd Mahathir B. Sayed Mohd Hamdan 152298

Noorhayati

Maznira

Haniza

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OUTLINE

Introduction

Maternal to Child Transmissions

Antiviral

Breast Feeding

Treatment Conclusion

Recommendations

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INTRODUCTION

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INTRODUCTION

Women living with HIV/AIDS in 2009 - 15.9million

Children living with HIV/AIDS in 2009 - 2.5million

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INTRODUCTION

HIV

The human immunodeficiency virus (HIV) is avirus that attacks the immune system

It is a lentivirus (a member of the retrovirusfamily) that causes acquiredimmunodeficiency syndrome (AIDS)

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MTCT

Mother-to-child transmission (MTCT) is whenan HIV-infected woman passes the virus toher baby. This can occur during pregnancy,labour and delivery, or breastfeeding

Without treatment, around 15-30% of babiesborn to HIV positive women will becomeinfected with HIV during pregnancy anddelivery. A further 5-20% will become

infected through breastfeeding.

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MTCT

In 2009, around 400,000 children under 15became infected with HIV, mainly throughmother-to-child transmission

About 90% of these MTCT infections occurred

in Africa where AIDS is beginning to reversedecades of steady progress in child survival

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FROM A MOTHER TO HER

BABY? An HIV positive woman can transmit the virusto her baby;

during pregnancy

labour and delivery

breastfeeding.

If she takes no preventive drugs andbreastfeeds then the chance of her babybecoming infected is around 20-45%

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ANTIVIRAL

Drug regimens starting earlier in pregnancy

Is better starting treatment until first trimester

(the first three months of pregnancy).

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ANTIVIRAL

If the drug Zidovudine (also known as AZT orZDV) is available it will often be suggestedthat you take it, starting from 28 weeks ofpregnancy (or as soon as possible thereafter)

AZT is usually taken two or three times daily.

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ANTIRETROVIRAL DRUG

TREATMENT? The aim of antiretroviral treatment is to keepthe amount of HIV in the body at a low level

The drugs are often referred to as:

antiretrovirals

ARVs

anti-HIV or anti-AIDS drugs

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WHO GUIDELINES FOR PMTCT DRUG

REGIMENS IN RESOURCE-LIMITED

SETTINGS

Pregnancy LabourAfter birth:mother

After birth: infant

2010Recommendationsoption A

AZT after 14weeks

single dosenevirapine;AZT+3TC

AZT+3TC forseven days

Daily NVP until 1week afterbreastfeeding hasfinished

2010

Recommendationsoption B

Triple ARVs after14 weeks

Triple ARVs

Triple ARVs until 1

week afterbreastfeeding hasfinished

6 weeks of dailyNVP

2006Recommendations

AZT after 28weeks

single dosenevirapine;AZT+3TC

AZT+3TC forseven days

single dosenevirapine; AZTfor seven days

Alternative

(higher risk ofdrug resistance)

AZT after 28

weeks

single dose

nevirapine -

single dose

nevirapine; AZTfor seven days

Minimum (lesseffective)

-single dosenevirapine;AZT+3TC

AZT+3TC forseven days

single dosenevirapine

Minimum (lesseffective; higherrisk of drug

resistance)

-single dosenevirapine

-single dosenevirapine

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BREAST FEEDING

While both mother and infant will takeantiretroviral drugs, have a very high success

Mothers are also advised to exclusivelybreastfeed their infant for 6 months and ,

introduce other food substances whilecontinuing to breastfeed for up to a year.

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BREAST FEEDING

Breastfeeding can also transmit HIV.

If no antiretroviral drugs are being taken,breastfeeding for two or more years candouble the risk of the baby becoming infected

to around 40%

Should avoid breastfeeding altogetherbecause the risk of HIV transmission

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TREATMENT

The latest (2010) guidance produced by theWHO, is that in order to reduce the risk of thebaby becoming infected, mothers, or their infant;

o are advised to take a course of antiretroviral

drugs throughout the breastfeeding period

While both mother and infant will take anantiretroviral drugs, who takes the longer courseof have a very high success

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WHAT IS COMBINATION

THERAPY?

Taking two or more antiretroviral drugs at a time

A combination of three or more anti-HIV drugs issometimes referred to as Highly Active

Antiretroviral Therapy (HAART)

Two or more antiretrovirals at the same timevastly reduces the rate, making treatment more

effective in the long term.

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ANTIRETROVIRAL DRUG REGIMENS

FOR PREGNANTWOMEN IN LOW ANDMIDDLE INCOME COUNTRIES IN 2008

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GUIDELINES 2006 AND 2010

2006 WHOInfant Feeding Guidelines 2010 WHOInfant Feeding Guidelines

Mother takes ARVs from 28th weekof pregnancy until 1 week afterlabour, or for an indefinite amount oftime if the mother is taking ARVs fortheir own health.

Mother takes ARVs from 14th weekof pregnancy until 1 week afterlabour, or for an indefinite amount oftime if the mother is taking ARVs for

their own health.

Short ARV regimen duringbreastfeeding period for eithermother and/or infant

Long ARV regimen duringbreastfeeding period for eithermother and/or infant

Exclusive breastfeeding for 6 months Exclusive breastfeeding for 6 months

Rapidly wean from breastmilk Gradually wean from breastmilk

No mixed feedingMixed (complementary) feed after 6months

Not recommended to breastfeedafter 6 months

Recommended to breastfeed and mixfeed in conjunction with ARVs

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r r ustigma of HIV/ AIDS:? HIV/ AIDS is a life-threatening illnesses.

Most people are afraid of HIV.

The disease is associated with a behavior(such as sex between men and injecting drug

users).

People living with HIV/ AIDS is usuallyviewed as responsible for their infection.

Moral and religious beliefs make peoplebelieve that HIV/ AIDS is the result of afailure of moral and religious and should bepunished.

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RECOMMENDATION

HIV blood tests before marriage.

HIV screening during pregnancy.

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CONCLUSION

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References

Memahami HIV dan AIDS di Malaysia. (2008, May 3).

Retrieved February 27, 2011, from Stigma and DiskriminasiHIV/AIDS: http://hivaidsmalaysia.blogspot.com

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Thank You