Prevention Mother To Child Transmission of HIV (PMTCT) dr. Femmy Tambajong,SpA Manado, 30 Maret 2011
PMTCT 1. Tindakan pencegahan primer terhadap HIV 2. Pencegahan terhadap kehamilan yang tidak direncanakan pada ibu terinfeksi HIV 3. Pencegahan transmisi HIV dari ibu ke bayi yang dikandungnya 4. Perawatan, dukungan dan pengobatan bagi ibu, anak dan keluarga yang terinfeksi HIV
Risiko penularan HIV dari ibu ke bayi tanpa intervensi PMTCT Periode transmisi
Risiko
•kehamilan
5-10%
•persalinan
10-20%
•menyusui
10-15%
Total
25-45%
KEHAMILAN: Penatalaksanaan Antenatal • Asuhan antenatal seperti biasa • Kurangi kadar virus (viral load) – Ibu minum ARV ARV TERAPI
ARV PROFILAKSIS
TUJUAN
MENCEGAH TIMBULNYA MENCEGAH AIDS PENULARAN HIV DARI IBU KE BAYI
PENGGUNAAN
JANGKA LAMA
KELAYAKAN PEMBERIAN KLINIS DAN KADAR CD4
MASA KEHAMILAN IBU HIV YANG HAMIL
PERSALINAN: penatalaksanaaan • Seksio sesarea elektif – Risiko transmisi terkecil – Mengurangi risiko penularan HIV ke bayi 50-60%
• Persalinan pervaginam – Risiko transmisi meningkat bila terjadi proses persalinan (inpartu) dan ketuban pecah dini
MENYUSUI REKOMENDASI TENTANG NUTRISI BAYI BAYI DARI IBU HIV
• ASI : makanan terbaik • Risiko penularan HIV melalui ASI sekitar 1520% • Risiko diperbesar dengan adanya lecet payudara (menjadi 63%)
Rekomendasi tentang nutrisi bayi • Apabila Ibu memilih untuk memberikan ASI, dianjurkan ASI eksklusif selama 6 bulan • Sangat tidak dianjurkan untuk menyusui campur (mix feeding) • Setelah 6 bulan, bayi diberi PASI dan ASI di stop
Rekomendasi tentang nutrisi bayi • Apabila ibu memilih memberikan susu formula Eksklusif maka harus memenuhi persyaratan AFASS: – Acceptable – Feasible – Affordable – Sustainable – Safe
Cumulative probability of HIV among 549 children born to HIV+ women
45 40
ASI eksklusif
35 30
Mix-feeding
25 20
Susu formula
15 10 5 0
AIDS 2001, 15:379-87
Rekomendasi tentang nutrisi bayi • Apabila ibu memilih memberikan susu formula Eksklusif maka harus memenuhi persyaratan AFASS: – Acceptable – Feasible – Affordable – Sustainable – Safe
ARV for baby Drug
Zidovudine - Gestational age > 35 weeks -
Gestational age 30-35 weeks
-
Gestational age < 30 weeks
Nevirapine
Dose 2 mg per kg body weight per dose given orally started as close to birth as possible (by 6-12 hours of delivery), then every 6 hours 2 mg per kg body weight per dose given orally every 12 hours, advanced to every 8 hours at 2 weeks of age 2 mg per kg body weight per dose given orally every 12 hours, advanced to every 8 hours at 4 weeks of age 2 mg per kg body weight given orally as single dose, between birth and 72 hours of age. Perinatal HIV Guidelines Working Group, 2008
WHO recommendation Recommended prophylactic ARV regimens for pregnant women who are not yet eligible for ART Mother Antepartum Intrapartum Postpartum
AZT starting at 28 weeks of pregnancy or as soon as feasible Sd-NVPb + AZT/3TC AZT/3TC × 7 days
Infant
Infant Sd-NVP + AZT × 7 days*
* If the mother receives less than four weeks of AZT during pregnancy, four weeks instead of one week of AZT is recommended WHO, 2006
US recommendation: AZT for 6 weeks Perinatal HIV Guidelines Working Group, 2008
Cipto Mangunkusumo Hospital protocol (2007) • Single dose nevirapine + zidovudine for 6 weeks
PHPT-2 protocol modification (Thai, 2004), formula feeding N Eng J Med. 2004;351:229-40
Immunizations recommendations Vaccine
WHO/UNICEF
ACIP
Asymptomatic
Symptomatic
HIV +
BCG
Yes (birth)
No
No
DPT
Yes ( 6,10,14 weeks)
Yes
Yes (acellular P)
Oral Polio
Yes (0,6,10,14 weeks)
Yes
No (IPV)
Measles
Yes (6 & 9 months)
Yes
Yes, if CD4>15%
Hepatitis B
Yes
Yes
Yes
Pneumococcus
-
-
Yes
Hib
-
-
Yes
Meningococcus
-
-
Yes
Influenza
-
-
Yes, age > 6 mos
Varicella
-
-
Yes
Yellow Fever
Yes
-
Yes Lancet Infect Dis 2004
Jadwal kunjungan PMTCT Saat lahir
10 hr
4 mgg
6 mgg
2 bln
3 bln
4 bln
6 bln
9 bln
18 bln
SF
SF
SF
SF
SF
SF
SF
SF-MP
SF-MP
SF-MP
BB/PB
Nutrisi ARV profilaksis (sdNVP 2mg/kg; AZT 2mg/kg/x, 4x/hari**
Kotrimoksazol
Imunisasi
Imunisasi sesuai jadwal IDAI/Depkes Perhatian khusus: BCG
Hb/Ht
PCR RNA/DNA
AB
Keterangan: BB = Berat Badan PB = Panjang Badan SF = Susu Formula MP = Makanan Padat Hb = Hemoglobin HT = Hematokrit PCR RNA/DNA = Polymerase chain reaction RNA/DNA AB = antibodi HIV ARV: antiretroviral, sdNVP: single dose nevirapin, AZT: zidovudin, **: dosis khusus untuk prematur
Thank you
