Thailand New National Guideline for PMTCT 2010 Suchat Hongsiriwon, MD Department of Pediatrics Chonburi Hospital

Regimen for pregnant women who never received ARV CD4 count cells/cu.mm ARV regimen duration of ARV start off ≤ 350AZT+ 3TC+ LPV/r rapidly continue ARV as guideline >350AZT + 3TC +LPV/rGA14wk off all ARV

Special conditions 1. In case of who got ARV before Pregnancy check CD4 & VL VL undetectable O.K VL ≥ 1,000 c/ml consult AIDS experts for proper regimen to suppress VL at undetectable 2.Poor or not good adherence : suitable regimen 3.Who got ARV < 4 wks : elective c/s & HARRT in newborn as who has no ANC

In labor continue ARV during pregnancy Plus AZT300 q 3h or AZT600mg SD even through R to AZT in order to adequate level in NB for PMTCT No SD NVP given except who on AZT monotherapy Beware to avoid of ergot eg. Methergin (use oxytocin) due to LPV or EFV usage may induce severe vasoconstriction

Pregnant who no ANC during labor Pregnant who just know HIV+ve during Labor sd NVP rapidly + AZT 300 mg q 3h until labor Post partum AZT + 3TC + LPV/r until know CD4 result If CD4 > 350 continue ARV 4wks then stop all CD4 ≤ 350 change to adult guideline /consult Med If expected that being labor within 2hr not give sd NVP but continue AZT 300mg q 3h or sdAZT600mg then start ARV later according to Thai adult guideline C/S after ARV > 2h can reduce PMTCT

ARV for experienced sdNVP mother ART for experience sdNVP exposed pregnant AZT + 3TC + LPV/r all immune status because of high risk of NVP resistance virus

PEP for Newborn : maternal no ANC Start ARV as fast as possible: AZT + 3TC + NVP AZT syr 4mg/kg/dose q 12 h 4-6wks 3TC syr 2mg/kg/dose q 12 h 4-6wks NVP syr 4mg/kg q 24 h 2-4 wks Stop AZT & 3TC after stop NVP 2 wks Recommend start ARV in NB at age ≤ 48 h

Guideline for Dx HIV infection in Children 2010 age<12mo age mo infected 1 st DNA PCR > 1mo 1 st anti HIV +ve -ve +ve -ve repeat 2-4wk age 4mo 2 nd antiHIV at age 18mo +ve -ve +ve -ve infected not infected infected not infected In-concordant In-concordant repeated 3 rd DNA rapidly repeated antiHIV at age 18 mo In age ≥ 18 mo 2x Anti HIV test

HIV infection in infant who was born from maternal HIV +ve at CBH Budget year No.of infant No. of HIV test No. HIV +ve MTCT rate3.33% 5.40% 5.12% 2.56% No.of lost to FU % % 11 22% % ©Oct 53 – Feb cases FU 21 Result negative all

Reference 1. แนวทางการตรวจและการดูแลรักษาผู้ติด เชื้อเอชไอวีและ ผู้ป่วยเอดส์ระดับชาติ ปี พ. ศ National Guidelines on HIV/AIDS Diagnosis and Treatment: Thailand Data from Chonburi Hospital, Pediatrics OPD from Oct -Feb 2011