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Clinical Practice Guildline

:
: HIV in Pregnancy
:
:
( )

:
( )

HIV 3
.. 2553 6,000
3.6
HIV 3
1. 9 23
2. 24 48 65
3. 12

1 HIV (HIV RNA level)
2 CD4 count
3 34
4 4

1. HIV HIV
2. HIV
3.
4. HIV
(2553)
HIV
HIV HIV
HIV CD 4 3
VL 36
HIV
HIV
HIV
HIV

2-8

: HIV in Pregnancy

HIV

(Pretest Counseling)
Anti HIV (Inform consent)

Positive

(Posttest Counseling)

Psychological support

HIV

CD4 VL
(High risk pregnancy)

Negative

Window period
3 - 6

HIV

3-8

: HIV in Pregnancy

1.
.. 2554
(HAART)

CD4

(2)

(3)

AZT (300 .) 1 x
3 .
AZT (600 .)

< 350(1)

AZT +3TC+LP/r

> 350

AZT +3TC+LP/r

14

(4)

AZT x 4
18

HAART EFV d4 T + ddl

AZT (200 300 .) 1 x 12 , 3 TC (150 .) 1 x 12 (AZT + 3 TC (300 . + 150 .) 1 x
12 ) LP/r (200 ./150 .) 2 x 12
14 CD4
AZT syrup 4 . / . x 12
2.
viral load (undetectable viral load)
(detectable viral load viral load 1,000 copies/mL
6 )

- AZT AZT
AZT
- EFV AZR + 3 TC
+ LPV/r EFV

4-8

: HIV in Pregnancy

1. CD4 200 cells/mm 3 PCP TMP SMX 2 1

, folic acid 1 1
2. CD4 100 cells/mm 3 crytococal meningitis fluconazole
HAART

CD4 count

- 6

Viral load

- 36

CBC

-
- AZT 8
- Hb < 8 g/dl Hct < 24% Hb < 8 g/dL Hct < 24%
AZT d4T
AZT d4T
AZT 3

ALT

- 2.5
upper limit NVP

-
2.5 upoer limit
EFV LPV/r
NPV

Urine sugar

Glucose challenge test

(GCT) 50 g

- LPV/r

- LPV/r
24 28 LPV/r
4
blood sugar 1 . 140 mg%
OGTT

CD4

AZT syrup 4 mg/kg/dose 12 . 4

SD NPV SD NPV

5-8

: HIV in Pregnancy

Scalp electrodes ,
ARM, F/E ,V/E
AZT
300 . 3 AZT 600 mg
AZT
SD NPV AZT mono therapy

CD4

- AZT syrup 4 mg/kg/dose 12 .
4
- SD NPV
SD NPV

6-8

: HIV in Pregnancy
Anti HIV no ANC
Anti HIV

Pretest counseling
Rapid test

Negative

Positive

Posttest counseling
HIV
3

Neg

Test 3

Neg

Pos

Test 2

Pos

Posttest counseling

HIV (no ANC)

-
1. NPV 200 mg AZT 300 mg. 3 . AZT 600
mg.
2. AZT + 3 TC + LPV/r CD4

7-8

: HIV in Pregnancy

(HAART)
CD4
< 350(1)
> 350

(2)

AZT (300 .) 1 x 3 . AZT+3TC+LP/r 4 - AZT +3TC x 4 6

AZT (600 .) HAART

- NVP x 2 4
AZT +3TC+LP/r
+ SD. NVP(1)
- 18
4

(1) 2
(2) AZT
4 ./. x 12
3 TC
2 ./. x 12
NVP
4 ./. x

NPV + AZT + 3 TC
- NPV syrup 4 mg/kg 24 . 2 4
- AZT syrup 4 mg/kg 12 .
- 3 TC syrup 2 mg/kg 12 . 4 6
( AZT + 3 TC NPV 2
48 .

48 .

1.
-
- 4 .
2. elective caesarean section
- 2 .
- HAART
- 4
- Viral load 36 1,000 copies/mL

8-8

: HIV in Pregnancy

Special obstetric complication

Management of preterm delivery and preterm pre-labour rupture of membranes
-

PPROM occurs after 34 week of gestation, Augmentation may be considered if the viral load less than 50
copies/ml and there are no obstetric contraindications

PPROM occurs before 34 week of gestation , national guidelines for the general population

Prolonged pregnancy :
-

on HAART with plasma viral load of less than 50 copies/ml no contraindication to membrane sweep or to use
of prostaglandins.

Reference
1. National Guidelines on HIV/AIDS Diagnosis and Treatment : Thailand 2010
2. Management of HIV in Pregnancy, RCOG Green-top Guideline 2010
3. Recommendations for Use of Antiretroviral Drugs in Pregnant HIV - 1 Infected Women for
Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States.
Sep. 14, 2011 ; pp 1 207