Question
An unbooked full-term pregnant woman in labor is brought into the emergency room. A rapid HIV and hepatitis B surface antigen were performed, and a third-generation rapid HIV antibody assay came back reactive. How will you proceed in this scenario:
| A. |
Get viral load done + start intravenous zidovudine prepartum and intrapartum + start the neonate on nevirapine + zidovudine
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| B. |
Get a fourth-generation HIV antigen + antibody test and then start zidovudine + start neonate on nevirapine
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| C. |
Shift the patient to the OT immediately for an emergency caesarian section with zidovudine infusion throughout + nevirapine prophylaxis in the neonate
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| D. |
Confirm the test with a western blot and then start zidovudine infusion + nevirapine prophylaxis
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Show Answer
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Correct Answer � A
Explanation
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Ans. A. Get viral load done + start intravenous zidovudine prepartum and intrapartum + start the neonate on nevirapine + zidovudine
If a mother gets positive during pregnancy, start HAART (first line popular combination TLE – Tenofovir +lamivudine +efavirenz) irrespective of the CD4 counts. The previous regime of isolated zidovudine administration is no longer recommended (less effective). Along with this peripartum zidovudine, the infusion is recommended when the HIV RNA load is > 1000 copies/ml
Neonatal prophylaxis is based on high-risk or low-risk categorization. Maternal viral load > 1000copies /ml anytime within 4 weeks of delivery, mothers who received less than 4 weeks of ART during pregnancy, or HIV acquire during pregnancy or breastfeeding are considered high risk.
High-risk babies must receive daily nevirapine once daily + twice daily zidovudine for 6 weeks of postnatal life. Low-risk babies can be put on nevirapine alone.
Exclusive breastfeeding in resource-limited settings and exclusive formula feeds in resource-rich settings.
Mixed feeds are contraindicated.
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