1. Claire Gamble Friday 30th June 2017
Baby, Birth and Beyond.
Claire Gamble
Friday 30th June 2017

2. Heartlands Paediatric Department
Regional Children's HIV service
Dr Steve Welch, Kate Ghandi (Pharmacist)
Yvonne and Claire (CNS’s)
Care of +ve children
Satellite clinics, Wolves, Cov, Leicester
Follow up of babies born to +ve moms

3. Antenatal screening for HIV, and impact

4. Mums-to-be

5. Mother-to-child-transmission
When an HIV positive woman passes the virus to her baby
during pregnancy, labour and delivery
during breastfeeding
Without treatment, around 15-30% of babies born to HIV positive women will become infected with HIV during pregnancy and delivery.
A further 5-20% will become infected through breastfeeding

6. Uptake of antiretroviral therapy and MTCT rate by year of birth for 3703 infants born to diagnosed women

7. New diagnosis Referral from screening midwife Reassure Obtain bloods
STI screen
Partner notification
Start to treat
Monitor carefully
Vaginal delivery if VL <40

8. Known positive Patient normally calls dept
Arrange to see to discuss concerns and worries
Monitor carefully
Vaginal delivery if <40

9. At Delivery VL <40 VL >40 NVD
Start baby on single HIV medication asap
Take bloods for HIV VL from mom and baby
VL >40
Recommend C section
AZT infusion
Plan may include other meds from mom
Start baby on triple HIV medication asap

10. Feeding
All mothers known to be HIV positive, regardless of antiretroviral therapy, and infant PEP should be advised to exclusively formula feed from birth.
It is well established that HIV can be transmitted from mother to child by breastfeeding. Evidence from Kenya puts the transmission rate at 16% over 2 years, accounting for almost half the total mother-to-child transmissions

12. Breast feeding
Intensive support and monitoring of the mother and infant are recommended during any breastfeeding period, including monthly measurement of maternal HIV viral load, and monthly testing of the infant HIV viral load.
Prolonged infant prophylaxis during the breastfeeding period, as opposed to maternal ART, is not recommended.

13. Inhibiting lactation
Cabergoline should be administered during the first day post-partum.
The recommended dose is 1 mg (two 0.5 mg tablets) given as a single dose.

14. Baby follow up VL at birth VL and development check at 6 weeks
VL and development check at 3 months
Antibody test at 2 yrs

15. Issues for positive children
Family dynamics
Confidentiality
Disclosure
Adherence/pill burden
Transition
Sexual health

16. Confidentiality & Disclosure
Children often not aware of parents diagnosis
Parents not always keen for the child to know their own diagnosis
Who to tell
School
‘BFF’s’, ‘Bae’s’
Partners

17. Adherence Big secret within family Reminder of diagnosis
Poor in all chronic conditions in adolescence
Can limit treatment options for future
Mental health issues

18. Pill burden Adult: 2 tablets daily: Kivexa + efavirenz 600mg
9 year old, 25kg child:
7½ tablets daily
abacavir 1½ tablets
lamivudine 2 x 100mg tablets
4 efavirenz capsules
200mg + 50mg +50mg + 50mg