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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. Guideline for Dx HIV infection in Children 2010 age<12mo age12 -18 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

9. HIV infection in infant who was born from maternal HIV +ve at CBH Budget year2550255125522553 No.of infant 56 52 50 48 No. of HIV test 31 37 39 No. HIV +ve 1 2 2 1 MTCT rate3.33% 5.40% 5.12% 2.56% No.of lost to FU 25 44.6% 15 28.94% 11 22% 9 18.75% ©Oct 53 – Feb 54 29 cases FU 21 Result negative all

10. Reference 1. แนวทางการตรวจและการดูแลรักษาผู้ติด เชื้อเอชไอวีและ ผู้ป่วยเอดส์ระดับชาติ ปี พ. ศ. 2553 National Guidelines on HIV/AIDS Diagnosis and Treatment: Thailand 2010 2.Data from Chonburi Hospital, Pediatrics OPD from Oct -Feb 2011