HIV In Pregnancy

Clinical description

HIV affects up to 15% of pregnancies in Malawi. Without any intervention, MTCT is as high as 45%.

With efficacious combination antiretroviral therapy (ART), this risk decreases to 1-5%.

Signs and symptoms

History/ExamRegardless of risk factors, all pregnant and breastfeeding women should be offered HIV testing in an opt-out approach.

InvestigationsPoint-of-care HIV testing should be offered to all HIV-negative women at 3-month intervals during the antenatal and breastfeeding periods.

In addition, HIV testing should be repeated in HIV-negative women:

(1) In the third trimester (2) In the labour ward if their last test was over 6 weeks ago (3) At the 6 week postnatal visit.

Antepartum Management

• All HIV-infected pregnant and breastfeeding women should be on ART.
• Start ART (for lifetime) regardless of WHO clinical stage and at any CD4 cell count, ideally on same day

as diagnosis.

• TDF/3TC/EFV is currently first-line therapy(regimen 5A).
• Start PrEP for serodiscordant couples (WHO 2012 guidelines)
• Screen for STIs, such as Hep B and syphilis, nutritional support, and family planning guidance
• TB symptom screening
• Start cotrimoxazole in all HIV-infectesd pregnant women, regardless of CD4count, WHO stage or

gestational age.

• Do not give SP to women on cotrimoxazole.
• Laboratory tests at the following time points
• At baseline: Cr, FBC, LFT, syphilis test, CD4 count, urinalysis

Intrapartum Management

• Vaginal delivery unless obstetric indication for caesarean delivery
• Continue ART during labour
• Instrument delivery should be avoided unless essential

Postpartum Managment

• Exclusive breastfeeding is encouraged up to 6 months and may continue breastfeeding up to 2 years of age
• Daily NVP syrup for infant for 6 wks (dose based on infant weight)
• Cotrimoxazole syrup for infant starting at 6 wks until final HIV testing resultsreturn as negative