Laboratory evaluation:
-
In every 3 to 4 months or approximately in each
trimester T-lymphocyte counts or HIV-1 RNA levels should be measured.
-
This will help in altering the therapy, to decide the route
of delivery, in starting prophylaxis for pneumocystis carinii pneumonia.
-
Testing for tuberculosis and other STDs should be done.
Prevention of opportunistic infections:
-
Vaccination should be given for hepatitis B, influenza,
pneumococcal infections.
-
If CD4+ count falls below 200/micro lit, primary
prophylaxis for P.carinii pneumonia is recommended with either sulfamethoxazole
– trimethoprim DS 1 tab/day or aerosolized pentamidine.
Prevention of HIV transmission to the infant:
-Preventive measures include – antiretroviral therapy,
cesarean delivery and withholding breast feeding.
-With combination antiretroviral therapy transmission rates
can be reduced to 1 to 2%.
-If no therapy is used the transmission rate is 10 to 28%.
-Scheduled cesarean delivery is recommended for HIV –
infected women with an HIV-1 RNA load of more than 1000 copies/ml regardless of
antiretroviral therapy.
-Better to do scheduled cesarean delivery at around 38 weeks
o lessen the chances of spontaneous membrane rupture or the onset of labor.
-Some authors contradict the scheduled cesarean delivery as
antiviral therapy itself can reduce the risk to 1 to 2%.
-Breast feeding increases the risk of neonatal transmission.
As around 16% of breast-fed infants develop infection it is not recommended
generally.
Measures to prevent HIV transmission to health-care
providers:
-
As history and clinical examination cannot identify
reliably all HIV infected patients, better to take blood and body-fluid
precautions consistently in all patients.
-
Gloves, surgical masks, protective eyewear, fluid
resistant gowns must be worn for all deliveries.
-
While handling the placenta or infant gown and gloves
should be used.
-
Mouth-suction devices to clear the airway should be
avoided.
-
If a glove is torn or neddlestick or any other injury occurs glove should be changed as
early as possible. That needle or instrument should be removed from sterile
field.
-
The health-care workers who got exposed to contaminated
fluids like needlestick injury should take post exposure prophylaxis with
zidovudine, 200mg thrice a day and lamivudine, 150mg thrice a day for 4 weeks.
-
If the source patient has advanced AIDS or a high load
HIV or has been treated with nucleoside analogues, then a protease inhibitor
such as Indinavir, 800mg thrice a day should be added.
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