Management of HIV Positive Woman in Pregnancy
If the HIV rapid test is positive, the mother should be informed of the result and counselled. She should subsequently referred for further management at the nearest High Risk Clinic (Hyperlink to list of High Risk Antenatal sites). Her CD4 panel must be done. She should have a detailed history and physical examination to determine her clinical stage.
New Diagnosis of HIV
If the CD4 is < 350 cells/mm3 or if history and examination reveals AIDS defining conditions, the mother requires HAART for her own health and this should be commenced as soon as this assessment is made. She should remain on HAART post delivery and be linked to treatment and care.
If the CD4 is> 350 cells/mm3 and the mother has no AIDS defining conditions, she requires HAART for prevention of vertical transmission of HIV and this should be commenced at 12 weeks (start of the second trimester). HAART should be discontinued post delivery and the mother should be linked to treatment and care.
Mothers Previously Diagnosed as HIV positive
If a mother was diagnosed as HIV positive prior to pregnancy but was not on HAART prior to pregnancy, she should be evaluated and placed on HAART as per the same recommendations stated above for the Newly Diagnosed HIV positive mother.
If a mother was diagnosed as HIV positive prior to pregnancy and was receiving HAART, she should continue the same medications but have CD4 panel and a Viral load to assess if her regime has been effective. If her CD4 is low and/or her viral load is elevated, consult an HIV specialist at an HIV Treatment Site (hyperlink to list of HIV Treatment Sites)(preferably the patient’s usual Treatment Site) to consider changing to a more effective regime. Adherence Issues should be addressed and the mother should be counselled.
The Unbooked Patient
An unbooked patient with a positive HIV Rapid Test should receive a stat treatment of Zidovudine 300mg, Lamivudine 150 mg and Lopinavir/ ritonavir 400/100 mg prior to delivery. She should subsequently have further follow up post delivery to ensure that she is linked to care and receives treatment for herself and her partner(s).
All HIV positive Mothers
- Should receive ongoing counselling and support. Many will find this diagnosis devastating. Many may have concerns about the health of the unborn child or the impact of this diagnosis on their families. Some may also have difficulties re taking medications.
- Should have a viral load test at 36 weeks. Consider the benefits of Elective Caesarean Section for preventing Mother to Child Transmission of HIV for mothers whose Viral load exceeds 1000 copies/ml.
- Should continue their ARVs throughout Labour and Delivery.
- Should have contact investigation so that partner(s) can also be evaluated.
- Should be linked to treatment and care post delivery
- Guidelines for the Elimination of Vertical Transmission of HIV & Syphilis, Ministry of Health, Jamaica