1. HIV (+) pregnant woman Prophylaxis of mother-to-child transmission Manegemant of a woman, who needs ARV medication

2. HIV mother-to-child transmission No embryopathy is observed. Newborns are asymptomatic. Virus may be transmitted - transplacentally - during labor - by breastfeeding Risk depends on stage of infection in mother ( HIV viremia) Risk about 25 % (Western/Central Europe, USA) 40% (Afr ic a)

3. HIV mother-to-child transmission Newborn infection rate is related to mother`s viremia : -viremia > 100 000 copies/ml - 41% -viremia 1000 - 10 000 copies/ml - 17% -viremia < 1 000 copies/ml - ~ 0% N. Engl. J. Med., 1999,341,394

4. Prophylaxis of mother-to-child transmission Antiretroviral treatment - cART in pregnancy starting at 16 – 28 week - Retrovir iv in a drip during labor: bolus 2 mg/kg (1 h), then 1 mg/kg/h until umbilical cord is clamped - newborn : Retrovir 4 mg/kg (syrup) every 12 h for 4 weeks (or cART if mother’s viremia is detectable) Caesarean section prior to amniotic membranes rupture (if viremia > 50 copies/ml) Newborn should be washed No breastfeeding Transmission rate has dropped to < 2 %

5. cART in pregnancy Combivir 1 tabl bid (Retrovir + 3TC) Kaletra 2 tabl bid Also accepted: Viramune, Invirase Videx, Zerit, Ziagen... Not recommended: Stocrin, Hivid

6. Prophylaxis of mother-to-child transmission About 36th week of pregnancy: - test HIV viremia - provide a woman with „labor set” Retrovir iv 1 vial Retrovir liquid 1 bottle - consider the mode of delivery caesarean section vaginal delivery HIV viremia > 50 copies HIV viremia < 50 copies

7. Mother`s seropositivity diagnosed during labor cART in mother, Retrovir iv during labor, Cesarean section (prior to amniotic membranes rupture) Retrovir in the newborn for 4 weeks + Viramune for 2 weeks (sometimes Kaletra for 4 weeks) + Epivir for 4 weeks If necessary continue cART in the mother

8. Prophylaxis of mother-to-child transmission – a case Patient aged 24, infected through intravenous drug use, seropositivity known since 4 years Admitted for check up in week 21 of pregnancy CD4 count 371 cells/mm3 HIV viremia 89 700 copies/ml Since week 22 of pregnancy she was given: Retrovir + 3TC + Kaletra Check up in week 36 of pregnancy: CD4 count 327 cells/mm3 HIV viremia <50 copies/ml She has delievered by caesarean section in week 40 of pregnancy During labor Retrovir iv was administered, newborn was given Retrovir in syrup Baby is not infected