From the Guidelines
Management of a 30-year-old HIV-positive primipara who has delivered a 2.8 kg baby requires a comprehensive approach addressing both maternal and infant care, with the mother continuing her antiretroviral therapy (ART) without interruption to maintain viral suppression, and the newborn receiving prophylactic antiretroviral medication within 6-12 hours of birth, as recommended by the most recent guidelines 1.
Key Components of Care
- The mother should continue her ART without interruption to maintain viral suppression. If she is not on treatment, initiate a regimen such as tenofovir/emtricitabine/dolutegravir immediately.
- For the newborn, prophylactic antiretroviral medication should be started within 6-12 hours of birth. The standard regimen is zidovudine (AZT) syrup at 4 mg/kg/dose twice daily for 4-6 weeks.
- If the mother had detectable viral load near delivery, a three-drug regimen may be indicated.
- The infant should not be breastfed in settings where safe formula feeding is available, as HIV can be transmitted through breast milk, but according to the WHO, mothers living with HIV should breastfeed for ≥12 mo and may continue breastfeeding for ≤24 mo or longer while being fully supported for ART adherence 1.
Monitoring and Follow-Up
- Early infant diagnosis is crucial, with HIV PCR testing recommended at birth, 4-6 weeks, 3 months, and 18 months.
- The mother needs close follow-up with viral load monitoring at 1-2 months postpartum and every 3-6 months thereafter.
- Psychological support and counseling about medication adherence are essential components of care.
Prevention of Mother-to-Child Transmission
- The risk of mother-to-child transmission of HIV can be significantly reduced through the provision of maternal ART as early as possible during pregnancy or preconception, and optimum nutritional support for pregnant and lactating women as well as their children 1.
- Rapid HIV testing, monitoring, and support for antiretroviral adherence as well as counseling on infant feeding are also critical components of care.
From the Research
Management of HIV Positive Primipara
- The management of a 30-year-old HIV positive primipara who has delivered a 2.8 kg baby involves several considerations, including the prevention of mother-to-child transmission of HIV and the treatment of the mother's HIV infection 2, 3.
- Antiretroviral therapy is recommended for the prevention of mother-to-child transmission of HIV, with options including lifelong therapy for all women or treatment until cessation of breastfeeding 2.
- The choice of antiretroviral therapy in pregnancy may be influenced by the indication, past antiretroviral therapy exposure, effects of pregnancy on the pharmacokinetics of the drug, and factors influencing tolerability and adherence 3.
Antiretroviral Regimens
- Different antiretroviral regimens, including those containing zidovudine, lamivudine, and ritonavir-boosted lopinavir, have been shown to contribute to HIV viral load reduction during pregnancy 4.
- The addition of lamivudine to zidovudine and lopinavir/ritonavir has been associated with a further reduction in viral load and a shorter time to achieve a viral load <50 copies/ml 4.
Mode of Delivery
- The mode of delivery for HIV positive women is often medically prescribed, with women's own preferences taking second place 5.
- Caesarean section may be recommended to reduce the risk of perinatal HIV transmission, but the decision should be made on a case-by-case basis, taking into account the individual woman's circumstances and preferences 5.
Post-Partum Care
- Post-partum care for HIV positive women should include ongoing antiretroviral therapy, as well as monitoring for potential adverse events and management of any complications that may arise 6.
- The risk of mother-to-child transmission of HIV can be reduced to less than 1% with appropriate management, including antiretroviral therapy and other interventions 3.