Prevention Mother To Child Transmission of HIV (PMTCT)

dr. Femmy Tambajong,SpAManado, 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 AIDS

MENCEGAH PENULARAN HIV DARI IBU KE BAYI

PENGGUNAAN JANGKA LAMA MASA KEHAMILAN

KELAYAKAN PEMBERIAN KLINIS DAN KADAR CD4 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 15-20%

• 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 toHIV+ women

0

5

10

15

20

25

30

35

40

45

ASI eksklusif

Mix-feeding

Susu formula

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

Drug Dose

Zidovudine

- Gestational age > 35 weeks 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

- Gestational age 30-35 weeks2 mg per kg body weight per dose given orally every 12 hours, advanced to every 8 hours at 2 weeks of age

- Gestational age < 30 weeks 2 mg per kg body weight per dose given orally every 12 hours, advanced to every 8 hours at 4 weeks of age

Nevirapine 2 mg per kg body weight given orally as single dose, between birth and 72 hours of age.

ARV for baby

Perinatal HIV Guidelines Working Group, 2008

MotherAntepartumIntrapartumPostpartum

AZT starting at 28 weeks of pregnancy or as soon as feasible Sd-NVPb + AZT/3TCAZT/3TC × 7 days

Infant Infant Sd-NVP + AZT × 7 days*

WHO recommendation

* If the mother receives less than four weeks of AZT during pregnancy, four weeks instead of one week of AZT is recommended

Recommended prophylactic ARV regimens for pregnant women who are not yet eligible for ART

US recommendation: AZT for 6 weeks

Perinatal HIV Guidelines Working Group, 2008

WHO, 2006

• Single dose nevirapine + zidovudine for 6 weeks

Cipto Mangunkusumo Hospital protocol (2007)

PHPT-2 protocol modification (Thai, 2004), formula feeding N Eng J Med. 2004;351:229-40

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

Immunizations recommendations

Lancet Infect Dis 2004

Jadwal kunjungan PMTCTSaat

lahir

10 hr 4

mgg

6

mgg

2 bln 3 bln 4 bln 6 bln 9 bln 18 bln

BB/PB

Nutrisi SF SF SF SF SF SF SF SF-MP SF-MP SF-MP

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/DNAAB

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 HIVARV: antiretroviral, sdNVP: single dose nevirapin, AZT: zidovudin, **: dosis khusus untuk prematur

Thank you