HIV in Pregnancy

Songchun He
Thea Rose Avila
 Definition
HIV stands for human immunodeficiency virus. HIV is a virus
that attacks the body’s immune system. In a healthy person,
the immune system protects the body from infections, cancers
and some diseases. Once HIV is in your blood, it controls and
kills CD4 cells (also called T cells). These cells help your immune
system fight disease.

HIV in pregnancy refers to the occurrence of HIV in a woman

during her pregnancy. During pregnancy, HIV can pass through
the placenta and infect the fetus. During labor and delivery,
the baby may be exposed to HIV in the blood and other fluids.
During breastfeeding, breast milk can transmit the virus to
the baby.
Anatomy & Physiology
1. Transmission to the Fetus
2. Immune System Impact
3. Effect on Pregnancy
4. Antiretroviral Therapy (ART)
5. Preventing Mother-to-Child Transmission (PMTCT)
6. Monitoring and Management
7. Counseling and Support
8. Postpartum Considerations
 Etiology
HIV disease in humans can be caused by infection with either HIV-1 or
HIV-2. HIV-1 is more prevalent of the two, has higher infectivity,
virulence, and greater spread through heterosexual sex. The
transmission rate of HIV from mother to child (vertical transmission) is
20% to 25% for HIV-1 versus about 5% for HIV-2. Vertical
transmission of HIV is possible not only throughout pregnancy but also
during childbirth and breastfeeding. Together this is termed as the
perinatal transmission of HIV.
Symptomatology
HIV has three stages of infection that have
different signs and symptoms:

Stage 1: Acute infection. This is the first 6

months of infection. About 4 to 9 in 10 people
with HIV (40 to 90 percent) have signs or
symptoms of flu within 2 to 4 weeks after
infection. During this stage, you have a large
amount of HIV in your blood and are very
contagious.
 Symptomatology
Stage 2: Clinical latency (also called HIV inactivity or dormancy).
During this stage, HIV is still active in the body, but it’s spreading
at low levels. You may not get sick or have signs or symptoms. If
you take ART the right away every day, you may stay in this
stage for several decades. At the end of this stage, your viral
load starts to increase and your CD4 count starts to decrease.
As this happens, you may begin to have flu-like signs or symptoms
as HIV levels rise in your body.

ART - Antiretroviral Therapy

 Symptomatology
Stage 3: AIDS. People with AIDS have extremely weak immune
systems and get more and more severe illnesses (also called
opportunistic infections or OIs). You have AIDS when your CD4
count drops below 200 cells/cubic millimeter or if you develops
certain OIs. If you have AIDS, you can have a high viral load and
easily spread HIV to others.
 General
Pathophysiology
 Laboratory &
Diagnostic Tests
Laboratory & Diagnostic Tests
Antibody tests look for antibodies to HIV in a person’s blood
or oral fluid. Antibody tests can take 23 to 90 days to detect
HIV after exposure. Most rapid tests and the only FDA-
approved HIV self-test are antibody tests. In general,
antibody tests that use blood from a vein can detect HIV
sooner after infection than tests done with blood from a
finger stick or with oral fluid.

For pregnant women, this test is often included in routine

prenatal care.
Laboratory & Diagnostic Tests
Antigen tests. More specifically known as p24 antigen tests.
They detect the presence of a protein present in HIV known
as p24. They are mostly used for early HIV detection. It is
often used in combination with an antibody test because it
does not pick up positive results very well. Also, this test is
not particularly useful after a while since the body begins to
produce antibodies and the concentration of p24 diminishes.
Laboratory & Diagnostic Tests
Nucleic Acid Tests (NATs). NATs look for the actual virus in
the blood. This test should be considered for people who have
had a recent exposure or a possible exposure with early
symptoms of HIV and have tested negative with an antibody
or antigen/antibody test. A NAT can usually detect HIV 10 to
33 days after exposure.
Laboratory & Diagnostic Tests
Viral Load Testing. Viral load testing measures the amount of
HIV RNA (genetic material) in the blood. It indicates how
actively the virus is replicating. Viral load monitoring is
important during pregnancy to assess the effectiveness of
antiretroviral therapy (ART) and to guide treatment
decisions.
Laboratory & Diagnostic Tests
HIV Testing During Labor. In some cases, rapid HIV testing
may be performed during labor for women with unknown HIV
status or those who did not receive prenatal care.

Infant Testing. After birth, the baby is tested for HIV using
nucleic acid tests. This helps determine whether transmission
occurred during pregnancy or childbirth.
Medical Treatment
Initiate ART early in pregnancy with a combination of
safe and effective medications.

Regularly monitor viral load and CD4 cell count;

adjust ART as needed.

Continue ART postpartum, provide guidance on

breastfeeding based on viral load.

Ensure a nutritious diet, offer psychosocial support,

and encourage adherence to medical
recommendations.
Pharmacologic Management
Antiretroviral therapy (ART): There is no cure for HIV infection.
Antiretroviral drugs can stop the virus from replicating in the body. The use
of antiretroviral medications during pregnancy, labor, and postpartum is a
critical component of preventing mother-to-child transmission. Initiating
ART early in pregnancy helps reduce the viral load and lowers the risk of
transmission.

Examples: Zidovudine (AZT), Lamivudine (3TC), Emtricitabine (FTC),

Tenofovir disoproxil fumarate (TDF)

Function: These drugs interfere with the reverse transcriptase enzyme,

crucial for the replication of the HIV virus.
Surgical Management
Cesarean sections are typically recommended for women with a high
HIV viral load (viral load greater than 1,000 copies/mL near delivery)
to minimize exposure of the baby to maternal blood and genital
secretions.

If the woman's viral load is well controlled with antiretroviral therapy

(ART), the risk of transmission may be lower, and a vaginal delivery
might be considered.
 Surgical Procedure
1. Administer anesthesia to numb the lower part of the mother's
body.
2. Position the mother on the operating table.
3. An incision is made through the abdominal wall and uterus.
4. Deliver the baby through the incisions.
5. Clamp and cut the umbilical cord.
6. Remove the placenta.
7. Close the uterine and abdominal incisions with sutures or staples.
 Nursing Interventions/
Postoperative Care
Monitor the mother’s vital signs and overall recovery closely as she wakes up from
anesthesia.
Administer prescribed pain medications as ordered.
Assist with position changes to find a comfortable position.
Use non-pharmacological pain relief measures, such as ice packs or heating pads.
Monitor the incision site for signs of infection, such as redness, swelling, or
discharge.
Instruct the mother on how to care for the incision, including keeping it clean and
dry.
Monitor and assist with the first voiding after surgery.
Encourage regular voiding to prevent urinary retention.
Assess for signs of urinary tract infection.
 Nursing Management
1. Encourage early and regular prenatal visits to monitor the
progression of the pregnancy.
2. Conduct a thorough health assessment to identify any additional
health concerns or complications.
3. Ensure that the pregnant woman is initiated on ART, following
current guidelines for HIV management during pregnancy.
4. Discuss the importance of adherence to antiretroviral therapy (ART)
and other aspects of HIV management during pregnancy.
5. Regularly monitor the mother’s viral load and CD4 count to assess
the effectiveness of the antiretroviral treatment.
Nursing Management
6. Administer ART as ordered to the newborn to prevent mother-to-
child transmission.
7.Provide guidance on breastfeeding options based on the woman's
viral load and other factors.
8.Regularly monitor the infant for HIV through testing especially in the
first few months of life.
9. Start the ART as soon as possible if the infant gets HIV from the
mother.
10 Educate the woman on ways to prevent the transmission of HIV to
sexual partners and others.
 Priority Nursing Diagnoses
1. Risk for Mother-to-Child Transmission of HIV.
Rationale: Preventing the transmission of HIV to the newborn is critical.

2. Knowledge Deficit related to HIV and Pregnancy.

Rationale: Ensuring the woman's understanding of HIV, its implications
during pregnancy, and the necessary interventions is crucial for effective
self-care and prevention. Providing education on HIV management during
pregnancy is a priority.

3. Risk for Infection.

Rationale: Pregnant women with HIV may be at an increased risk of
opportunistic infections due to immunocompromised status.
Priority Nursing Diagnoses
4. Noncompliance with Antiretroviral Therapy.
Rationale: Adherence to antiretroviral therapy is vital for the woman's
health and the prevention of mother-to-child transmission.

5. Risk for Complications during Labor and Delivery.

Rationale: The mode of delivery is a crucial consideration to minimize
the risk of transmission during childbirth. Assessing the woman's
health status and collaborating with the healthcare team to develop a
safe labor and delivery plan are top priorities.
Prognosis
When treated with appropriate antiretroviral therapy and comprehensive
prenatal care, the prognosis for pregnant women with HIV is generally
favorable, with a significantly reduced risk of transmission to the baby.

However, if left untreated, there is an increased risk of mother-to-child

transmission and potential complications for both the mother and the
infant.
 References
HIV and Pregnancy. (n.d.). ACOG. https://www.acog.org/womens-
health/faqs/hiv-and-
pregnancy#:~:text=If%20I%20am%20pregnant%20and,the%20virus%20to%20t
he%20baby.
HIV / AIDS - symptoms and causes | Penn Medicine. (n.d.).
https://www.pennmedicine.org/for-patients-and-visitors/patient-
information/conditions-treated-a-to-z/aids-and-hiv
World Health Organization: WHO & World Health Organization: WHO. (2023, July
13). HIV and AIDS. https://www.who.int/news-room/fact-sheets/detail/hiv-aids?
gclid=CjwKCAiAkp6tBhB5EiwANTCx1FPs9g2fYpn-lZ1vOGLcEgEtoiaWO-mN-
t7O7Slbggna7K9r2CD6yRoCi60QAvD_BwE
C-section - Mayo Clinic. (2022, June 16). https://www.mayoclinic.org/tests-
procedures/c-section/about/pac-20393655
Thank you!