NSG 504: Perinatal Infections: Human Immunodeficiency Virus [Lowdermilk]

Infants should receive oral zidovudine for _____ after birth.

6 weeks Lecture: Infants 6 week course of antiretroviral therapy after birth Additional Reading: It should be given during labor if the woman is having a vaginal birth (The Panel). Artificial rupture of membranes, fetal scalp electrode, and scalp pH sampling should be avoided because these procedures may result in inoculation of the fetus with the virus. Similarly the use of forceps or vacuum extractor should be avoided when possible (The Panel).

Both clinical and epidemiologic studies have shown that declining ______ levels are strongly associated with increased incidence of AIDS-related diseases and death in many different groups of HIV-infected people.

CD4

Approximately 47,500 new _____ infections occur in the United States each year. An estimated 20% of these new infections occur in women. Black women are estimated to have 64% of these infections, white women are estimated to have 18%, His- panic women, 15%, and American Indian women less than 1%

HIV

Thorough ______ is essential because of the greatly increased incidence of abnormal findings on examination (CDC, 2010c). In addition, HIV-positive women should be screened for syphilis, gonorrhea, chlamydia, and other vaginal infections and treated if infections are present. General prevention strategies are an important part of care (e.g., smoking cessation, sound nutrition) as is antiretroviral therapy. Discussion of the medical care of HIV-positive women or women with AIDS is beyond the scope of this chap- ter because of the rapidly changing recommendations. The reader is referred to the CDC (www.cdc.gov), CDC National AIDS hotline (800-342-2437), and Internet websites such as HIV/AIDS Treatment Information Service (www.hivatis.org) for current information and recommendations.

Pap screening

Perinatal transmission of HIV has decreased significantly since 2004 because of the administration of ______ prophylaxis (e.g., zidovudine) to pregnant women in the prenatal and the perinatal periods.

antiretroviral

Avoidance of ______ is recommended in the United States and most developed countries (CDC, 2010; The Panel).

breastfeeding

In the intrapartum period ART and _______ are recommended to prevent vertical transmission of HIV (The Panel, 2012). The Panel recommends a scheduled cesarean birth at 38 weeks of gestation for women with a ______ of more than 1000 copies/ml. A vaginal birth may be an option for HIV-infected women who have a viral load of fewer than 1000 copies/ml at 36 weeks, if a woman has ruptured membranes and labor is progressing rapidly, or if she declines a cesarean birth.

cesarean birth viral load Lecture: Cesarean section as the method of delivery depending on viral load Additional Reading: IV zidovudine is recommended during the intrapartum period for HIV-infected pregnant women with viral loads of more than 400 copies/ml or unknown HIV status (The Panel). The drug is administered 3 hours before a scheduled cesarean birth and continued until the baby is born.

Although HIV antibody ______, definitive diagnosis of HIV in children younger than 18 months is based on laboratory evidence of HIV in blood or tissues by culture, nucleic acid, or antigen detection

crosses the placenta

Transmission of the virus from mother to child can occur throughout the perinatal period. Exposure may occur to the fetus through the maternal circulation as early as the first trimester of pregnancy, to the infant during _______ by inoculation or ingestion of maternal blood and other infected fluids, or to the infant through breast milk

labor and birth

ART is administered orally and continued throughout pregnancy. The major side effect of this therapy is bone marrow suppression. Periodic hematocrit, white blood cell count, and platelet count assessments should be performed (The Panel, 2012). Women who are HIV positive should also be vaccinated against hepatitis B, pneumococcal infection, Haemophilus influenzae type B, and viral influenza. To support any pregnant woman's immune system, appropriate counseling is provided about optimal _____, sleep, rest, ______, and stress reduction. Condom use is encouraged to minimize further exposure to HIV from a sexual partner who may be a source.

nutrition exercise

HIV and Pregnancy HIV counseling and testing should be offered to all women at their initial prenatal care visit as part of _____ unless the woman opts-out of the screening (CDC, 2010c).

routine prenatal testing Additional Reading: Universal testing is recommended versus selective testing for maternal HIV because it results in a greater number of women being screened and treated and can reduce the likelihood of perinatal transmission and maintain women's health (CDC). The CDC also recommends retesting in the third trimester for women known to be at high risk for HIV and rapid HIV testing in labor for women with unknown HIV status.

Treatment of HIV-infected women with the ______ or _______ during pregnancy has been reported to decrease the mother-to-child transmission to 1% to 2% (CDC, 2010c).

triple-drug antiretroviral therapy (ART) highly active antiretroviral therapy (HAART) Lecture: decreases vertical transmission to 1%.