Hiv &hepatitis

lecture for medical students

1. human immunodeficiency virus ( HIV ) by Dr.Tarig Mahmoud Ahmed MD SUDAN HAIL UNIVERSITY KSA

2. The HIV virus is an RNA retrovirus

3. Transmission Horizontal: transmitted through sexual contact, blood and blood products Vertical (mother-to-child). Peri natal: occurs in the late third trimester, during labour or delivery ---80% breastfeeding --28% Most of the pregnant women with HIV have acquired their infection through heterosexual exposure.

4. Screening Routine antenatal screening has increased detection rates and new treatments have increased life expectancy. all pregnant women should be offered screening in pregnancy because antenatal interventions can reduce maternal-to-child transmission of HIV infection from 25 to 30% to less than 2 %.

5. counselling Ensure that the woman understands the reasons for screening. Appropriate interventions would be of benefit to her baby. Reassured about confidentiality and support, If she be positive. Disclosure of the HIV diagnosis to her partner should be handled with sensitivity.

6. Clinical features Infection with HIV begins with an asymptomatic stage with gradual compromise of immune function eventually leading to acquired immunodeficiency syndrome (AIDS). The time between HIV infection and development of AIDS ranges from a few months to as long as 17 years in untreated patients.

7. Factors Increased risk of transmission to child Advanced maternal HIV disease. High maternal plasma viral load. Low CD4 lymphocyte counts. Prolonged rupture of membranes. Chorioamnionitis. Preterm delivery. Obstetric interventions such as FBS or fetal scalp electrodes. Coexisting viral infections e.g. herpes and hepatitis C. Breastfeeding doubles transmission rate.

8. Management Interventions to reduce the risk of HIV transmission are: Low or undetectable viral counts at time of delivery. Anti-retroviral therapy, given antenatally and intrapartum to the mother and to the neonate for the first 4–6 weeks of life. Delivery by elective Caesarean section. Avoidance of breastfeeding.

9. Women who do not require HIV treatment for their own health require antiretroviral therapy to prevent mother-to-child transmission usually commenced between 28 and 32 weeks of gestation and should be continued intrapartum.

10. Lactic acidosis is a recognized complication of highly active antiretroviral therapy (HAART) regimens and may mimic the symptoms and signs of pre-eclampsia. Where this condition is suspected, liver function tests and blood lactate should be monitored.

11. Mode of delivery An elective vaginal delivery is an option for women taking triple drug antiretroviral therapy who have a viral load below 50 copies/ mL at the time of delivery. Women who planned for vaginal delivery should have their membranes left intact for as long as possible. Use of fetal scalp electrodes and fetal blood sampling should be avoided.

12. Caesarean section A Caesarean delivery is recommended if a woman is taking monotherapy , or if viral load is a bove 50 copies/ mL at the time of delivery. A Caesarean delivery should be recommended for women with hepatitis C co infection as the risk of transmission is higher.

13. Management of infants Cord should be clamped as early as possible after delivery and the baby should be bathed immediately after the birth. NO breast feeding. All infants born to women who are HIV positive should be treated with antiretroviral therapy from birth for 4–6 weeks. PCR is used for the diagnosis of infant infection, typically, tests are carried out at birth, then at 3 weeks, 6 weeks and six months.

14. Hepatitis B

15. The hepatitis B virus (HBV) is a DNA virus

16. Transmission Transmitted: mainly in blood other body fluids such as saliva, semen and vaginal fluid.

17. Lab results

18. Screening screening for HBV should be offered to all pregnant women so that effective post-natal intervention can be offered to infected women to decrease the risk of mother-to-child transmission. 85 % of babies born to mothers who are positive for the hepatitis e antigen ( HBeAg ) will become HBsAg carriers and subsequently become chronic carriers, compared with 31% of babies who are born to mothers who are HBeAg negative.

19. Mother-to-child transmission of the HBV is approximately 95 % cent preventable through administration of vaccine and immunoglobulin to the baby at birth.

20. Clinical features Hepatitis B is a virus that infects the liver, but many people with hepatitis B viral infection have no symptoms. The HBV has an incubation period of 6 weeks to six months.

21. Management Women who screen positive for hepatitis B should be referred to a hepatologist . To prevent vertical transmission of hepatitis B, a combination of hepatitis B immunoglobulin and hepatitis B vaccine may be given.

22. The passive immunoglobulin provides immediate protection against any virus transmitted to the baby from contact with blood during delivery, The active vaccine provides ongoing protection from subsequent exposure in the household. The active vaccine is given in three doses: at birth, at one month and at six months of age.

23. Mode of delivery Mode of delivery does not appear to have a significant effect on vertical transmission Manage delivery to minimize risk of vertical transmission by avoiding fetal blood sampling and fetal scalp electrodes where possible. Breastfeeding is not a risk factor for mother-to-child transmission of hepatitis B virus.

24. Hepatitis C

25. Hepatitis C is a RNA virus

26. Transmission Transmitted through infected blood products and injection of drugs. It can also occur with tattooing and body piercing. Mother-to-child transmission can occur due to contact with infected maternal blood around the time of delivery, and the risk is higher in those co infected with HIV. Sexual transmission is extremely rare.

27. Screening Current recommendations are that pregnant women should NOT be offered routine screening for HCV, because there is a lack of evidence-based effective interventions for the treatment of HCV in pregnancy, and a lack of evidence about which interventions reduce vertical transmission of HCV from mother to child.

28. Clinical features It is one of the major causes of liver cirrhosis, hepatocellular carcinoma and liver failure. Following initial infection, only 20% of women will have hepatic symptoms, 80% being asymptomatic. The majority of pregnant women with hepatitis C will not have reached the phase of having the chronic disease, and may be unaware that they are infected.

29. Management Testing for HCV involves detection of anti-HCV antibodies in serum with subsequent confirmatory testing by PCR for the virus, if a positive result is obtained. Upon confirmation of a positive test, a woman should be offered post-test counselling and referral to a hepatologist for management and treatment of her infection .

30. In non-pregnant adults, interferon and ribavirin can be used to treat hepatitis C infection, but these are contraindicated in pregnancy.

31. mode of delivery There is no strong evidence regarding mode of delivery in women with hepatitis C. elective Caesarean section NOT recommended for all women with hepatitis C, although it is recommended if the woman is also HIV positive. Breastfeeding is not a risk factor for mother-to-child transmission of hepatitis c virus.

32. Thank you for your attention