ARVT to Mother and Child : Interventions to Reduce Vertical Transmission

4th Pediatric Infectious Diseases Conference

ISSN 0973 - 0958

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TREATMENT OF HIV INFECTION

Interventions to Decrease Rate Of Vertical Transmission

Related topics

Immunization

Dr. Nitin Shah
Hon. Pediatrician- UHC, LTMG Hospital, Mumbai.
Treasurer, Indian Academy of Pediatrics, 1998-2001

Different types of interventions have been tried to ultimately decrease the rate of vertical transmission, which includes:

Primary prevention of HIV in would-be mothers.
Vit. A supplementation and nutritional support.
Elective caesarian section.
Cleaning of birth canal during delivery
Immunotherapy of mother and child.
Avoidance of breast-feeding.
Anti-retroviral drug therapy

On one hand, HIV is definitely transmitted via breast milk and has 5% extra risk of transmission to the baby; on the other hand exclusive top feeding especially with a bottle will lead to increased incidence and mortality due to ARI and diarrhea. Besides giving top feeding to all estimated 75000 babies born to HIV mothers in India will cost Rs. 75million per month.

Hence the policy to allow breast-feeding in such a case should be based on the one to one basis. If the mother is educated, intelligent and affording, breast-feeding should be discouraged. However if she is uneducated, ill affording and cannot make top feeds safely, breast-feeding should be encouraged. Recent studies have shown that mixed feeding is worst for such babies, as they will be exposed to both HIV as well as to the ill effects of top feeding.

The decision taken by the mother should always be respected even if it is contrary to local policies.

ARVT to mother and child :
Giving ARVT drugs to mother and child to block vertical transmission is very exciting and rewarding. There are three protocols used for these purpose:

076 protocols:
here the HIV infected mother is started on single drug AZT from 14-35 weeks of gestation as soon as she registers. It is given in the dose of 100 mg 4 times a day daily till day of delivery. During labor it is given IV in the dose of 1mg per kg. body weight per hour till baby is delivered. The baby is started on oral AZT in the dose of 8 mg per kg body weight in 4 divided doses, starting within 12 hours of birth. Such complete course will reduce the transmission by 66%.

However this protocol is very long, costly and needs compliance by the patient, which is difficult in our setting. In India, mothers do not come early for registration and many are not tested routinely for HIV making the implementation of this protocol difficult. Hence there is need to develop newer, shorter protocol for developing countries. Two such protocols have been developed as discussed below:
Thai protocol:
Here mother is given AZT in the dose of 300 mg 2 times a day orally only in the last month of gestation. On the day of delivery, she is continued on the oral dose every 3 hourly. The baby is not given the drug. This protocol has shown 50% reduction in transmission. Slight reduction in efficacy is well accepted, as this protocol is short, cost effective making the compliance better and implementation easy.
Nevirapine protocol:
Here the mother is given Nevirapine in only a single dose of 200 mg at the onset of labor and the baby is given a single dose of 2mg per kg body weight at 24-48 hours of age. This protocol has shown efficacy of 50%, which is excellent, especially as it needs to be given as only a dose to the mother and the baby. It is also very cost effective. It can also be administered to the mother who is unregistered or not HIV tested before labor.

Last created on 23-02-2001
Last updated on 28-05-2007

Next : Initiation Of Antiretroviral Therapy

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