HIV in Mothers and Children
HIV in Mothers and Children
HIV in Mothers and Children
Children
What Is HIV/AIDS?
• Acquired immunodeficiency syndrome
(AIDS) is caused by the human
immunodeficiency virus (HIV).
2
What Is HIV/AIDS?
• The immune system of an HIV-infected
person becomes so weakened that it
cannot protect itself from serious
infections. When this happens, the
person clinically has AIDS.
• Sexual intercourse
• Accidental exposure to blood/blood
products (e.g., blood transfusions,
shared needles, contaminated
instruments)
• Mother to child during:
– pregnancy
– birth
– breastfeeding 6
Women and HIV
Social Risk Factors
– Illiteracy
– Lack of awareness of preventive measures
Biological risk factors
– Twice as easy for women to contract HIV from
men
– Physiology of women (e.g., menstruation,
intercourse)
– Pregnancy-associated conditions (e.g., anemia,
menorrhagia and hemorrhage) increase the
7
need for blood transfusion
HIV and Contraception
• Contraception with protection
– Male condom (latex and vinyl)
– Female condom
– Nonoxynol-9 (antiviral spermicidal cream)1
– Diaphragm1
• Methods appropriate for use by women with
HIV. They should use a condom for their
partner’s protection.
– Hormonals (COCs, Implants, PICs)
–Partial
1 Voluntary sterilization
protection if used without condom 8
Effect of AIDS on Pregnancy
• Infertility
• Repeated abortions
• Prematurity
• Intrauterine growth retardation
• Stillbirths
• Congenital abnormalities
• Embryopathies
9
HIV Transmission from Mother to
Infant
• Antenatal
– In utero by transplacental passage
• Intranatal
– Exposure to maternal blood and vaginal
secretions during labor and delivery
• Postnatal
– Postpartum through breastfeeding
Source: UNAIDS/WHO 1996; UNAIDS/WHO 1998. 10
HIV Transmission from Mother to
Infant
• MEDICAL NEEDS
ZDV NVP
3 DAYS 10.4% 8.2%
6-8 WKS 21.3% 11.9%
14-16 WKS 25.1% 13.1%
SO WHAT?
• EFFICACY OF SHORT-COURSE NVP 47%
GREATER THAN SHORT COURSE ZDV
25
20
15
less than 4 h
10 greater than 4 h
0
% Infants Infected
OBSTETRICAL PRACTICE
MODE OF DELIVERY - VAGINAL
• ARTIFICIAL RUPTURE OF MEMBRANES
SHOULD BE AVOIDED
• RUPTURE OF MEMBRANES PAST 4 HOURS
SHOULD BE AVOIDED
• FETAL SCALP SAMPLING AND THE USE OF
SCALP ELECTRODES SHOULD BE AVOIDED
MODE OF DELIVERY:
EUROPEAN MODE OF DELIVERY
COLLABORATION – MARCH, 1999
12
10
8
C-S
6
Vag.
4
0
% INFANTS INFECTED
MODE OF DELIVERY:
EUROPEAN MODE OF DELIVERY
COLLABORATION – MARCH, 1999
45
40
35
30 less than 1,000
25 1,001-10,000
20 10,001-50,000
15 50,001-100,000
10 more than 100,000
5
0
% INFANTS INFECTED
BREASTFEEDING IN HIV
POSITIVE WOMEN
INTRODUCTION
• HIV DNA PRESENT IN BREAST MILK
• HIV TRANSMISSION CAN OCCUR
THROUGH BREASTFEEDING
• BREASTFEEDING IS AN INDEPENDENT
RISK FACTOR FOR HIV TRANSMISSION
EVIDENCE TO SUPPORT
TRANSMISSION
• ISOLATION OF HIV-1 FROM CELLULAR
& NON-CELLULAR FRACTIONS OF
BREAST MILK
• CASE REPORTS OF INFECTED CHILDREN
BREASTFED BY MOTHERS WHO
ACQUIRED HIV POSTPARTUM
EVIDENCE TO SUPPORT
TRANSMISSION
• DOCUMENTATION OF OTHER
RETROVIRUSES TRANSMITTED THROUGH
BREAST MILK
• AVOIDANCE OF BREASTFEEDING IS
CONTROVERSIAL AND DEPENDS ON
INTERNAL MILIEU
• DEVELOPING COUNTRIES VS
INDUSTRIALIZED COUNTRIES
POLICIES
• UNAIDS REVISED STATEMENT 1998:
WOMEN SHOULD BE OFFERED HIV
COUNSELING AND TESTING, BE
INFORMED OF RISKS AND BENEFITS OF
BREASTFEEDING IF THE MOTHER IS HIV
POSITIVE, AND SHOULD MAKE A
DECISION THAT TAKES INTO ACCOUNT
THE INDIVIDUAL &FAMILY SITUATIONS
MECHANISM OF
TRANSMISSION
• EXACT MECHANISM OF TRANSMISSION
THROUGH BREAST MILK STILL NOT
WELL UNDERSTOOD
• INFECTION VIA CELL-FREE HIV IN BREAST
MILK OR VIA HIV-INFECTED CELLS
• SUSCEPTIBILITY OF IMMATURE NEONATAL
GI TRACT TO VIRUS
• GI TRACT MUCOSAL DAMAGE
DURATION OF
BREASTFEEDING