Case Study HIV

Tricia M.
Lanzar
BSMLS-3B
Vertical Transmission of HIV
Introduction
A woman with HIV can transmit the virus on to her kid if she does not receive the proper
treatment and care. This is known as vertical transmission or mother-to-child transmission
(MTCT). Vertical HIV transmission (VT) occurs when HIV is passed from mother to child during
pregnancy, birth, or breastfeeding. The prevalence of VT varies between 13 and 48 percent. VT
rates have been reduced to less than 2% through preventive methods. The most vulnerable times
for HIV VT are during pregnancy, birth, and lactation. The primary independent risk factor for
transmission is the maternal viral load (VL). VT is frequently exacerbated by certain sexually
transmitted illnesses (STDs). Similarly, low maternal CD4 cell counts are a risk factor for VT,
which is unrelated to VL. The prevalence of vertical transmission (VT) varies by geographic
location and, more precisely, by the contribution of economic resources invested by different
countries worldwide in various strategies for healthcare policies aimed at the prevention and
treatment of infected mothers.
Case Presentation
A 22 year-old woman has recently given birth to her first child. Her now two month old
baby boy is brought into the clinic for a check up. He appears to be healthy but his HIV positive
mother is concerned about his HIV status. She was tested during the first trimester of pregnancy
and was found to be HIV positive. A second, confirmatory test was also positive but she was not
started on HAART. She did not take nevirapine at the onset of labour and her baby was not given
nevirapine within three days after birth. For the first month the baby was breast fed exclusively
but for the past month he has received mixed feeds- bottle and breast feedings.
Discussion
All pregnant women should be offered an HIV test at their first antenatal visit. If the results
are negative they should be offered a second test at 34 weeks. For mothers who test HIV positive
with a CD4 count of <350 or stage 4 disease irrespective of CD4 count or MDR/XDR TB
irrespective of CD4 count. If these patients meet adherence criteria they are fast-tracked and
initiated on ARVs within 2 weeks of receiving their CD4 result and choosing to start lifelong
ARVs. Those who do not initially meet adherence criteria are started on cotrimoxazole both as
prophylaxis and as an adherence test. Once patients have demonstrated the ability to adhere they
are started on antiretroviral drugs.
Diagnosis
Differential Diagnosis Baby may have contracted HIV from transmission of virus from
infected mother. Baby may be HIV negative because transmission is only 20-30% from infected
mother to her child. Examination Baby appears healthy All vitals are normal Baby weighs 4.5 kg
(25th percentile for weight) No other abnormalities detected Investigations PCR testing for HIV to
see if baby is infected.Final outcome PCR results show that the baby is HIV negative. The mother
is counseled and educated to exclusively bottle feed and thereby try to avoid transmission.
Cotrimoxazole given daily until 18 months old. At 18 months the baby must have an antibody HIV
test.
Conclusion
PCR the only test that should be done on a child this age because any baby born to a sero-
positive mother will also be sero-positive for the first 12 to 18 months of life. For this reason, it is
useless to test the baby at two months using an HIV rapid test. The test may still be reading the
mothers antibodies which passed the placenta to the baby. Until maternal antibodies disappear the
baby will continue to test sero-positive. Before 18 months the best test for a definitive diagnosis is
PCR.
Transmission can be prevented from the mother to child when a pregnant mother is
diagnosed as HIV positive, she should have a CD4 count and viral load test done. If the mother’s
count is cotrimoxazole treatment for use as both prophylaxis and as an adherence test. Once
patients have demonstrated the ability to adhere they are started on ARV’s. If her CD4 count is
above 350 cells/mm3 then she must follow the national PMTCT guidelines starting zidovudine
from 14 weeks, single-dose Nevirapine and Zidovudine 3-hourly during labour and single dose
tenofovir and emtricatibine after delivery. If a women presents in labour without having started
either ART or the PMTCT regimen at 14 weeks, she should still receive the single-dose Nevirapine
and Zidovudine 3-hourly and Tenofovir and Emtricitabine as per above.
Regardless of the mother’s treatment, the recommended prophylactic treatment in all
babies born to HIV-positive mothers should be given prophylactic cotrimoxazole from the age of
six weeks until they are HIV-negative. Cotrimoxazole is protective of the pneumonias common to
HIV-infected babies, it saves lives and prevents infections and immune decline. If the baby is not
HIV-infected, then cotrimoxazole usually does no harm.
All babies are routinely tested for HIV in order to establish the efficacy of the interventions.
The following tests are performed: At 6 weeks do PCR testing At 18 months do antibody testing.
Nursing poses a cumulative danger; the longer an HIV-positive mother breastfeeds, the greater the
risk of transmission through breastfeeding. Breastfeeding transmission can account for up to half
of HIV infections in newborns and young children in areas where breastfeeding is widespread and
extended.
Reference
 Dr. Monica Mercer, ( 2019 ). HIV+ mother to infant transmission case study. Retrieved
May 6, 2022, from https://www.immunopaedia.org.za/clinical-cases/mother-to-child-
transmission/a-high-risk-pregnancy/
 E.V. Rubio, (2014) Vertical Transmission of HIV — Medical Diagnosis, Therapeutic
Options and Prevention Strategy. Retrieved from: 10.5772/61202

Case Study HIV

Uploaded by

Copyright:

Available Formats

Case Study HIV

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Case Study HIV

Uploaded by

Copyright:

Available Formats

Tricia M.

You might also like