Toolkit Revision Summary

SUMMARY OF PERINATAL HIV PREVENTION TOOLKIT CHANGES
Second Edition, released September 2008

Acknowledgements:

  1. First Edition – Release Date, March 2006

          Authors:

  • Mary Campbell Bliss, RN, MS, CNS
  • William Gilbert, MD
  • Jan Lanouette, MD
  • Courtney Nisbet, RN, MS
  • David Wirtschafter, MD
  • Paul Wozniak, MD,
  • Tracy Weber, MN, RNC

     2.  Second Edition - Release Date, September 2008

           Authors:

  • Mary Campbell Bliss, RN, MS, CNS
  • William Gilbert, MD

Legislation and Reporting:

  1. AB 682 (chaptered 10/07) simplified the HIV testing and documentation requirements.
  2. Information regarding HIV testing of pregnant women may be given by people providing prenatal or intrapartum care, which means that staff other than physicians may provide education and document any refusal of the testing in either the prenatal or hospital setting.
  3. The State of California has developed HIV education forms in English and 11 other languages, which provide information about pregnancy and HIV testing6.  (http://www.cdph.ca.gov/pubsforms/forms/Pages/AIDS.aspx)

Management of HIV Positive HIV Tests during Pregnancy:

  1. HIV post-test counseling for women who test positive should include information about the availability of highly active antiretroviral therapy (HAART) for treatment of HIV and prevention of perinatal HIV transmission.

Treatment of HIV Infection during Pregnancy:

  1. All pregnant HIV infected women should be offered highly active antiretroviral therapy (HAART) to maximally suppress viral replication, reduce the risk of perinatal transmission, and minimize the risk of developing resistant virus
  2. The monotherapy with the three-part zidovudine (ZDV) prophylaxis regimen, previously thought to be acceptable for women with HIV RNA viral load <1,000 copies/mL, is now considered controversial and most experts will treat with triple nucleosides-trizivir twice a day. (See new perinatal guidelines included in revised HIV Toolkit.)
  3. Recommendations for resistance testing for HIV infected pregnant women now also apply to those women with a new diagnosis of HIV infection of unknown duration.

Perinatal HIV Transmission and Mode of Delivery:

  1. In caring for the HIV-infected pregnant woman, provide the most complete and current information regarding use of antiretroviral therapy, mode of delivery, and other issues, including:
  2. AZT-containing regimen
  3. Avoid scalp electrodes
  4. Avoid episiotomies (if possible)
  5. Avoid any procedure that may increase risk of fetal contact with maternal blood or vaginal secretions.
  6. Consultation with a HIV specialist is highly recommended

Newborn Care for Infants Born to HIV Positive Mothers:

  1. Consult with a Pediatric HIV Specialist in regards to appropriate dosage for Lamivudine and lopinavir/ritonavir administration.  These agents (other than zidovudine) have not been tested in premature infants; therefore the dose in premature infants is unknown.

 Additional New References:

  1. State of California, Office of Aids Forms, http://cdph.ca.gov/pubsforms/forms/Pages/AIDS.aspx
  2. American College of Obstetricians and Gynecologists (ACOG) (2007).  Committee Opinion #389, Human Immunodeficiency Virus.
  3. Branson, BM, et. al, Revised Recommendations for HIV Testing of Adults, Adolescents and Pregnant Women in Health Care Settings.  MMWR Recommendation Report. 2006; 55(RR-14):1-17; quiz CE 1-4.
  4. Guidelines for the Use of Antiretroviral Agents in HIV 1 Infected Adults and Adolescents.  January 29, 2008.  Available at:  http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf.

 

 

PERINATAL HIV PREVENTION TOOLKIT, REVISED 10/08 - Newsletter Article

  1. Article Text (45 KB Microsoft Word Document)
  2. RPPC Perinatal Care Matters Newsletter, Winter 2008 (400.3 KB PDF document)

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