HIV: Prevention, mother-to-child transmission

Not all children born to seropositive mothers will be infected. Why some children are infected and others are not is a topic of intensive research. Seropositive women are advised to avoid conception. However, there are many women or married couples who do want a child to symbolically overcome death via their progeny. Breast-feeding should be discouraged if there is an alternative, though the latter is often not the case. Perinatal administration of Retrovir® definitely lowers the risk of transmission. In an American-European study in which Retrovir® was given IV to the mother throughout the third trimester of pregnancy and during childbirth and to the child for 4 weeks a decrease in transmission from 22% to 8% was observed. Shorter schemes with Retrovir® are also effective. Retrovir® appears to be tolerated very well by babies, with only minimal side-effects. In Third World countries Retrovir® will often be beyond the scope of many patients. Perinatal transmission can be reduced by 50% by a single administration of 200 mg nevirapine (Viramune®) to the mother during childbirth and by one dose (2 mg/kg) to the baby within the first 3 days of life. This should be a cheap strategy in Third World countries for reducing intra-partum transmission and transfer via the early maternal milk. Elective Caesarean section carries a significantly lower risk of transmission (about 10%). The advantage of a Caesarean section diminishes when the amniochorionic membranes are broken and/or the mother is already in labour. Combining prophylactic Retrovir® with elective Caesarean section can reduce the risk of vertical transmission to about 2%. The possible place of HAART in this setting is still not clear. Episiotomy, internal monitoring (in any case a luxury), forceps and vacuum extraction are best avoided in vaginal childbirth. After birth, the child should be gently aspirated, the eyes and nose flushed and given a quick bath to remove all blood. Optimal nutrition with enough vitamin A before giving birth is advised (the possibly inhibitory effect of certain retinoids on HIV is being investigated).

Category: Medical Subject Notes , Medicine Notes , Microbiology Notes , PSM Notes