HIV/AIDS IN PREGNANCY

INTRODUCTION
HIV-Human Immunodeficiency Virus
AIDS- Acquired immunodeficiency
Syndrome
CD4 cells
 EPIDEMIOLOGY
Affects all age groups
Reproductive age group
Affects both sexes
Female / male 55:45
AIDS– 4th commonest cause of death
worldwide
40 million people living with HIV/AIDS
– About 18 million women & 3 million children
 IN NIGERIA
Prevalence is 5.2% (5-6 million people)
No state or community is spared by this
epidemic
Ranges from 1.2% in Osun state to 12% in
Cross River State
13 States & FCT- prevalence over 5%
Rivers State -9%
UPTH antenatal patients - 8-10%
 TRANSMISSION

3 MAJOR MODES OF TRANSMISSION

1- SEXUAL INTERCOURSE -(80%)
Homosexual, Heterosexual > in Dev. Countries

2-TRANSFUSSION OF BLOOD & COMPONENTS

(10%)

3-MOTHER TO CHILD TRANSMISSIOM - MTCT

(5-10%)
FACTORS AFFECTING MTCT
Maternal Viral Load
Stage of Maternal Disease
Stage of Pregnancy 1st<2nd<3rd trimester
Mode of Delivery
Duration of Rupture of Membranes
Prematurity
Breastfeeding
 PATHOPHYSIOLOGY
INCUBATION PERIOD
Generally, 2-3 months
6 months in some individuals
1 month with current Anti HIV assays
Asymptomatic Period 2-10 years, may be shorter,
depending on;
-Virulence of organism
-Viral load
-Viral resistance
 Pathophysiology Contd.
HIV –RNA retroviruses
2 serotypes; HIV 1 & HIV 2
HIV 1 more widespread & more virulent
HIV 2 milder & commoner in West Africa
HIV primarily affects CD4 T-lymphocytes
HIV membrane protein gp 120 + CD4 receptors
Infected cell+reverse transcriptase =Proviral DNA
Viral replication = gradual depletion of CD4 count
Absence of ART= devp. of disease manifestations
 EFFECTS OF HIV/AIDS ON
PREGNANCY
More marked in developing countries;
These include;
Spontaneus abortion
Ectopic pregnancy
Maternal infections
Vaginal candidiasis
Preterm labour & low birth weight
IUGR
Stillbirth
Anaemia
EFFECTS OF PREGNANCY ON
HIV/AIDS

Little or no effect on the asymptomatic in

early stages of HIV disease

More rapid progression in late HIV/AIDS

 CLINICAL PRESENTATION
Broad spectrum of illness in severity & diversity
Primary infection associated with a brief illness about the time
sero-conversion
Symptoms include;
Fever
Malaise
Headache
Arthralgia
Maculopapular rash
Tender lymphadenopathy
Diarrhoea
Mouth ulcers
Followed by an asymptomatic phase (2-10 YEARS)
 Clinical presentation
Symptomatic phase;
Weght loss - 10% of body weight
Fever of 1 month duration
Diarrhoea of 1month duration
Herpes zooster
Lymphadenopathy
Dermatitis
Oral hairy leucoplacia
This phase termed – AIDS RELATED COMPLEX
 FULL BLOWN AIDS
Occurrence of opportunistic infections
Tuberculosis
Pneumocystic carini pneumonia
Cerebral toxoplasmosis
Cryptococcal meningitis
AIDS dementia
Diarrhoea & wasting syndrome
Oesophageal candidiasis
Cytomegalovirus retinitis
Malignancies like;
Kaposi’s sarcoma
Non Hodgson’s lymphoma
Mycobactrium avium intra celulare complex infections (mac)
 INVESTIGATIONS
GENERAL;
FBC
E/U/Cr
URINALYSIS & URINE M/C/S
CXR
LFT
Pap smear
SPECIFIC;
HIV SEROLOGY TEST (ELISA)
VIRAL LOAD
CD4 COUNT
CD8 COUNT
WESTERN BLOT (CONFIRMATORY)
POLYMERASE CHAIN REACTION especially in children
THANK YOU