Background: Women diagnosed with HIV/AIDS may transmit the infection to their child during pregnancy. The infection may spread during pregnancy, childbirth, or breastfeeding. However, the risk of mother-to-child transmission of HIV may be reduced by the use of HIV medications known as antiretroviral therapy (ART). Infection with HIV/AIDS is not a contraindication to pregnancy. Some women are unaware they have the disease until they become pregnant. In this case, they should begin antiretroviral therapy as soon as possible [1]. With the appropriate treatment, the risk of mother-to-child infection can be reduced to below 1% [2]. Without treatment, the risk of transmission is 15% - 45% [3]. Objective: The main aim of the study is to appreciate the declining trend of HIV in babies with HIV positive mother by implementation of PPTCT services. Methods: A retrospective study of detection of HIV positive mothers among all the antenatal patients attending OPD and including the patients coming in Emergency services and delivered in Department of Obstetrics and Gynecology at MGMMC & M. Y. Hospital, Indore, Madhya Pradesh (India) from Jan 2006 to Dec 2015 was included in the study. They were screened for HIV status and further management of all HIV positive patients.
The human immunodeficiency virus (HIV) is a lentivirus (a subgroup of retrovirus) that causes HIV infection and over time acquired immunodeficiency syndrome (AIDS) [
HIV infects vital cells in the human immune system such as helper T cells (specifically CD4 + T cells), macrophages, and dendritic cells [
To take follow-up of those with HIV positive serology up to their delivery and their babies after delivery.
To analyze the declining trend among HIV positive detected patients over a period of 10 years i.e. from Jan. 2009 to Dec. 2015.
To appreciate the declining trend of HIV in babies with HIV positive mother by implementation of PPTCT services in MYH from Jan. 2009 to Dec. 2015.
To detect rate of transmission according to method of delivery and treatment received during pregnancy.
A retrospective study of detection of HIV positive among all the antenatal patients attending OPD and including the patients coming in Emergency services and delivered in Department of Obstetrics and Gynecology at MGMMC & M. Y. Hospital, Indore, Madhya Pradesh (India) from Jan. 2009 to Dec. 2015 were included in the study. They were screened for HIV status and further management for all HIV positive patients.
The incidence of HIV has dropped consistently i.e. from 1.4% in 2006 to 0.11% in 2015 as in
Year | Total antenatal OPD | Pre-test counselled | Tested (ANC + emergency) | HIV reactive |
---|---|---|---|---|
2006 | 6422 | 4261 | 2122 | 31 |
2007 | 7055 | 5130 | 3888 | 32 |
2008 | 7600 | 5839 | 4691 | 31 |
2009 | 7693 | 6724 | 6194 | 29 |
2010 | 9138 | 8479 | 6099 | 29 |
2011 | 7594 | 7288 | 6594 | 35 |
2012 | 7884 | 6672 | 9797 | 21 |
2013 | 9481 | 7288 | 10,494 | 25 |
2014 | 11,314 | 8843 | 17,363 | 35 |
2015 | 9935 | 9960 | 13,274 | 15 |
Year | Total deliveries | HIV positive cases | Percentage (in %) |
---|---|---|---|
2009 | 9335 | 38 | 0.4 |
2010 | 11,216 | 38 | 0.33 |
2011 | 9847 | 50 | 0.50 |
2012 | 10,226 | 60 | 0.58 |
2013 | 9000 | 46 | 0.51 |
2014 | 10,366 | 58 | 0.56 |
2015 | 10,835 | 46 | 0.42 |
Year | Vaginal deliveries (in percentage) | LSCS (in percentage) |
---|---|---|
2009 | 36.8 | 63.1 |
2010 | 5.2 | 92.1 |
2011 | 38 | 62 |
2012 | 58.3 | 41.6 |
2013 | 63 | 34.7 |
2014 | 48.2 | 44.8 |
2015 | 71 | 29 |
Deliveries. According to recent guideline, Elective LSCS is not recommended. It is evident from the data in
Year | Total vaginal deliveries | Reactive babies in vaginal deliveries | Total LSCS | Reactive babies in LSCS |
---|---|---|---|---|
2009 | 14 | 0 | 24 | 0 |
2010 | 2 | 0 | 35 | 1 |
2011 | 19 | 1 | 31 | 0 |
2012 | 35 | 1 | 25 | 2 |
2013 | 29 | 1 | 16 | 1 |
2014 | 27 | 0 | 29 | 0 |
2015 | 33 | 0 | 13 | 0 |
In accordance to NACO and PPTCT, Tablet NVP 200 mg should be given 2 hours before planned delivery or at onset of labour. The newborn should be given nevirapine suspension. Now it has been changed to TLE Regimen to mother for atleast 24 weeks & NVP to baby. According to recent guideline, Elective LSCS is not recommended. Mixed feeding should be avoided. Only Breast feeding should be continued in developing countries. None of the babies were found to HIV reactive at the end previous 2 years irrespective of mode of delivery as in
Year | Total number of deliveries | Alive healthy babies | Intrauterine death | Nursery | Certified |
---|---|---|---|---|---|
2009 | 38 | 33 | 0 | 5 | 0 |
2010 | 38 | 35 | 0 | 3 | 3 |
2011 | 50 | 45 | 1 | 4 | 6 |
2012 | 60 | 42 | 3 | 5 | 2 |
2013 | 46 | 42 | 1 | 3 | 0 |
2014 | 58 | 53 | 2 | 3 | 0 |
2015 | 46 | 48 | 2 | 6 | 0 |
It was because of novel approach of NACP and PPTCT counselling enabling the antenatal women to be diagnosed earlier. In 2009 only 29 patients were found to be reactive w.r.t 2015 there were 15 patients who were reactive at our institute.
Most of the patients are getting delivered at a tertiary care center (MYH), thus ensuring the Prophylactic and Postnatal care of the mother and baby.
The risk of vertical transmission of HIV from mother to baby ranges from 7% - 40%. Maternal HIV transmission is the primary means by which infant become infected. Hence prevention of maternal HIV transmission is of paramount importance. The Indian Council of Medical Research initiated a serosurveillance among high risk group to ascertain the magnitude of HIV infection at regular intervals so as to know the trends and patterns of the disease in the community which would facilitate proper prevention and management.
The study was conducted on all the HIV positive antenatal patients attending OPD and including the patients coming in Emergency services and delivered in Department of Obstetrics and Gynecology at MGMMC & M.Y. Hospital, Indore, Madhya Pradesh (India) from Jan 2006 to Jan 2016. During this study period, there were 338 deliveries in these 7 years from Jan 2009 to Dec 2015. The most common route of infection is sexual transmission more commonly through male to female w.r.t female to male. So the fetus becomes the innocent bearer of the disease. These children were called at 6weeks, 6 months and 18 months for follow up.
The PPTCT program has significantly improvised its ANC OPD burden from 6422 in 2006, 9138 in 2010 to 9935 in 2015 among those for HIV screening as in
According to Kesho Bora study, Infants of mothers with undetectable virus levels after being given Triple ARVs at time of delivery has only 2.7% risk of HIV infection at the end of one year. So initiation of ARVs early in pregnancy and to all women who require ART irrespective of CD4 count as per 2013 guidelines significantly eliminate risk of Mother to Child HIV Transmission.
There were 338 deliveries from 2009 to 2015, 298 babies were found to be alive healthy and 11 were certified.29 went to nursery and 9 were with Intrauterine fetal demise.
In accordance to NACO and PPTCT, Tablet NVP 200 mg should be given 2 hours before planned delivery or at onset of labour. The newborn should be given Nevirapine suspension. Now, it has been changed to TLE Regimen to mother for at least 24 weeks & NVP to baby.
For preventing MTCT, Triple ART should be started irrespective of CD4 count and clinical stage.
The 2010 revised PMTCT guidelines refer to the following two key approaches:
1) Lifelong ART for HIV-infected women in need of treatment for their own health, which is also safe and effective in reducing mother to child transmission of HIV (MTCT).
2) Short-term ARV prophylaxis to prevent MTCT during pregnancy, delivery and breastfeeding for HIV-infected women not in need of treatment.
Eligibility for treatment:
The 2006 guidelines recommended starting lifelong ART for pregnant women with a CD4 count equal to or below 200 cells/mm3, usually the stage at which the immune system is no longer strong enough to prevent opportunistic diseases.
The 2010 guidelines promote starting lifelong ART for all pregnant women with severe or advanced clinical disease (stage 3 or 4), or with a CD4 count at or below 350 cells/mm3, regardless of symptoms. The new ART eligibility criteria, which are the same as those for adults in general, emphasize the need for access to CD4 testing.
Both the previous and new PMTCT ARV guidelines recommend that HIV positive pregnant women in need of treatment for their own health should start ART irrespective of gestational age and should continue with it throughout pregnancy, delivery, during breastfeeding and thereafter.
In both sets of guidelines, the timing of ART initiation for HIV-positive pregnant women is the same as for non-pregnant women, i.e. as soon as the eligibility criteria are met. Women are the same as for non-pregnant women, i.e. as soon as the eligibility criteria are met [
・ Following guidelines can prevent Parent to Child transmission.
Malhotra, A. and Yadav, S. (2016) A Retrospective Study of Impact of PPTCT on HIV Trends, Maternal and Perinatal Outcome. World Journal of AIDS, 6, 178-185. http://dx.doi.org/10.4236/wja.2016.64020