hiv prophylaxis in pregnancy - smileydoc
|
hiv prophylaxis in pregnancy - smileydoc
|
04-14-2008, 02:10 PM
Hello forum members...what is the guideline for HIV prophylaxis in pregnancy?.
Do both mum and baby get prophylaxis or just mum alone?. Anyone????
04-14-2008, 02:17 PM
prophylaxis... an hiv mom....is azt from 2 trimester...till delivery...child recieves for azt for 6 weeks
if the mom was already taking drugs...u never stop it...thought in 1st trim but if her cd4 count is too low we give triple drug therapy to mom... correct me if wrong.... according to my senior dh ..he says triple drug therapy should be given to all moms.... i am saying what kaplan 2007 states....will mark what kaplansays in exam.... if 2008 kaplan states something else...pls do notify
04-14-2008, 02:36 PM
triple therapy given to all moms w cd4 55,000
or any viral load and any cd4 wt did kaplan exactly sad please stef
01-28-2009, 04:55 PM
wht is HIV prophylaxy in pregnancy? is this right?
01-28-2009, 05:12 PM
prophylaxis... an hiv mom....is azt from 2 trimester...till delivery...child recieves for azt for 6 weeks
if the mom was already taking drugs...u never stop it...thought in 1st trim but if her cd4 count is too low we give triple drug therapy to mom... correct me if wrong.... according to my senior dh ..he says triple drug therapy should be given to all moms.... i am saying what kaplan 2007 states....will mark what kaplansays in exam.... if 2008 kaplan states something else...pls do notify.. kaplan 2009 dont sy dat much abut hiv prophy in pregnancy??any idea????
01-28-2009, 08:33 PM
Zidovudine (Retrovir) should be included in the antiretroviral regimen of pregnant patients with human immunodeficiency disease regardless of their viral load or CD4+ cell count.
The most recent recommendations from the Centers for Disease Control and Prevention (CDC)18 regarding optimal antiretroviral therapy are to treat pregnant women infected with HIV the same as adults infected with HIV who are not pregnant using clinical, virologic and immunologic status to guide treatment decisions. One difference for pregnant women is to include zidovudine in every treatment regimen given the extensive data demonstrating its benefits. FDA Pregnancy Categories of Antiretroviral Drugs Category A None Category B Didanosine (Videx) Nelfinavir (Viracept) Ritonavir (Norvir) Saquinavir (Fortovase) Category C Abacavir (Ziagen) Amprenavir (Agenerase) Delavirdine (Rescriptor) Efavirenz (Sustiva) Indinavir (Crixivan) Lamivudine (Epivir) Nevirapine (Viramune) Stavudine (Zerit) Zalcitabine (HIVID) Zidovudine (Retrovir) Approved for patients less than 1 year of age Abacavir Didanosine Lamivudine Nevirapine Stavudine Zidovudine Interventions to Decrease the Rate of Vertical Transmission of HIV Zidovudine therapy Highly active antiretroviral therapy Suppressing maternal viral load to undetectable levels Elective cesarean section at 38 weeks Prevention of opportunistic infections Prevention of preterm delivery Reducing time between rupture of membranes and delivery to less than four hours Minimizing fetal exposure to maternal blood Summary of Modifications to Care for Obstetric Patients with HIV Infection First trimester Screen pregnant patients for HIV infection. Measure viral load and CD4+ lymphocyte count. Initiate highly active antiretroviral regimen. If antiretroviral naïve, may delay therapy until second trimester. Include zidovudine (Retrovir) in antiretroviral regimen. If CD4+ cell count is less than 200 per mm3 (200 X 106 per L), initiate PCP prophylaxis. Update influenza and pneumococcal vaccinations if appropriate. Obtain necessary social support for patient. Second trimester Measure viral load and CD4+ cell count. Modify antiretroviral regimen based on viral load. If CD4+ lymphocyte count is less than 50, initiate MAC prophylaxis. Check PPD status. If PPD is positive, administer isoniazid (INH) and pyridoxine (vitamin B6) prophylaxis. Third trimester Measure viral load and CD4+ lymphocyte count. Modify antiretroviral regimen based on viral load. Discuss risks and benefits of elective cesarean section. If elective cesarean section is planned, perform at 38 weeks of gestation. If vaginal delivery is planned, minimize fetal exposure to maternal blood during delivery. If vaginal delivery is planned, deliver less then four hours after rupture of membranes. Infant Initiate zidovudine therapy. * The key to preventing MTCT of HIV in the United States is universal HIV testing of pregnant women. * The AAP recommends "opt out" consent or "right of refusal." After being notified that testing will be performed, all pregnant women in the United States should undergo routine HIV testing unless they decline this testing. * To further decrease the rate of perinatal HIV transmission, repeated testing in the third trimester may be helpful, particularly in high-risk groups. * Rapid HIV testing at labor and delivery may also be helpful, using new, rapid testing methods that can identify HIV-infected women or HIV-exposed infants in 20 to 60 minutes. * Women in labor with undocumented HIV infection status during the current pregnancy should undergo immediate rapid HIV antibody testing with opt-out consent. * Immunofluorescent antibody or Western blot assay should be used to confirm positive HIV antibody screening test results, but prophylaxis should not be delayed while awaiting definitive test results. * Preventing MTCT of HIV is most effective when antiretroviral drugs are given to the mother during her pregnancy, continued through delivery, and then given to the newborn infant. * Antiretroviral drugs are effective in reducing the risk for MTCT of HIV even when prophylaxis is started for the infant soon after birth. * When rapid HIV antibody test result is positive in a pregnant woman, antiretroviral prophylaxis should be promptly given to the mother and newborn without waiting for results of confirmatory HIV testing. * If the confirmatory test result is negative, prophylaxis should be discontinued. * When the mother's HIV serostatus is unknown, rapid HIV antibody testing should be performed on the mother or on the newborn, and results should be reported to the healthcare professional within 12 hours after the infant's birth. * If the rapid HIV antibody test result is positive, antiretroviral prophylaxis should be started as soon as possible and no later than 12 hours after delivery. * Pending completion of confirmatory HIV testing, the mother should be counseled not to breast-feed, but she should be assisted with immediate initiation of hand and pump expression to stimulate milk production. * If the confirmatory test result is negative, prophylaxis should be stopped and breast-feeding may begin. * If the confirmatory test result is positive, the mother should not breast-feed, and the infant should receive antiretroviral prophylaxis for 6 weeks after birth. Pearls for Practice * The key to preventing MTCT of HIV in the United States is universal HIV testing of pregnant women, using "opt out" consent or "right of refusal." To further decrease the rate of perinatal HIV transmission, repeated testing in the third trimester may be helpful, particularly in high-risk groups. New methods of rapid HIV testing at labor and delivery may identify HIV-infected women or HIV-exposed infants in 20 to 60 minutes. * Preventing MTCT of HIV is most effective when antiretroviral drugs are given to the mother during her pregnancy, continued through delivery, and then given to the newborn infant. Immunofluorescent antibody or Western blot assay should be used to confirm positive HIV antibody screening test results, but prophylaxis should not be delayed while awaiting definitive test results.
01-28-2009, 08:33 PM
CDC Updates 2001 Guideline on HIV Prophylaxis Following Occupational Exposure
* Exposures to HIV-infected blood, cerebrospinal, synovial, pleural, peritoneal, pericardial, amniotic, vaginal fluids, and semen are all considered potentially infectious for HCP. Larger quantities of blood pose a higher risk for infection also. Nasal or fecal secretions, saliva, sputum, sweat, tears, urine, and vomitus are not considered potentially infectious unless they are visibly bloody. * HIV PEP should begin early in association with infectious disease consultation, and reevaluation should occur within 72 hours. Two-drug regimens are recommended for low-risk and three- or four-drug regimens for higher-risk exposures.
01-28-2009, 08:34 PM
Treatment Protocols for Postexposure Prophylaxis After Sexual Assault
Treatment regimen (28 days) Zidovudine, 300 mg twice daily or 200 mg three times daily and Lamivudine, 150 mg twice daily Alternative regimen (28 days) Didanosine, 200 mg twice daily and Stavudine, 40 mg twice daily Consider adding* Nelfinavir, 750 mg three times daily or Indinavir, 800 mg three times daily Testing of victim HIV antibody test (repeat at 6 weeks, 3 months and 6 months) Hepatitis B virus antibody test Gonorrhea, Chlamydia and syphilis tests Wet mount for trichomonas Pregnancy test (if appropriate) Hepatic enzyme levels (repeat as clinically indicated) Complete blood count (repeat as clinically indicated) HIV = human immunodeficiency virus. *--A protease inhibitor should be added when the assailant is known to be infected with HIV resistant to reverse transcriptase inhibitors. Adapted with permission from Bamberger JD, Waldo CR, Gerberding JL, Katz MH. Postexposure prophylaxis for human immunodeficiency virus (HIV) infection following sexual assault. Am J Med 1999;106:323-6.
01-28-2009, 08:45 PM
stefan you are cent percent correct ..the boss is never wrong!
|
| « Next Oldest | Next Newest » |
