27 year old male, came to me with HIV positive report and he was in WHO stage 3 illness. When i asked about his wife's report, he told that she is pregnant ( 5th RMOA ) and tested negative at 3rd RMOA.
But during history taking he revealed that he wasn't tested for HIV at that time and he had intercourse after that also, so i advised Western blot report for his wife. Unfortunately the report of his wife was positive, not all but antibodies against GP120, GP41 and P24 were positive.
I advised viral load, which was 29000 viral copies. I started her on Tenofovir + Emtricitabine + Efavirenz based regime. Luckily after 3 months her viral load was undetectable level.
She was delivered full term with planned LSCS. The baby's weight was 3.4 kg and procedure was non complicated. I didn't allowed BF to baby ( A debatable issue ) and started Nevirepine + Zidovudine.
Baby's DNA PCR was negative at the end of six week. So I started Syrup Septran and repeated DNA PCR at the age of 6th Month and it was also negative. Elisa test after 18th month was also negative.
Now just think what would have happened if The Husband hadn't stage 3 illness and he would not have tested for HIV?
Take home Message is:
1. Test Pregnant woman as early as possible once pregnancy signs are positive, and also test the husband at same time if possible.
2. Also test mother at 5th month and 8th month.
3. If husband is HIV positive than prefer Western Blot testing.
4. If mother turns HIV reactive than do Viral Load and CD4/CD8 counts and Drug Resistance Testing if husband is on therapy and viral load of mother is more than 2000 viral copies.
5. Start ART & Don't wait for the report, select regime according to Husband's Medicine & Don't stop mother's ART after delivery, its lifelong.
6. Prefer LSCS if feasible.
7. Avoid Breast Feeding if feasible, especially Mix feeding ( Highest Transmission risk ).
8. Test baby at 6week ( DNA PCR ), 6th Month ( DNA PCR ) and 18th month ( ELISA ).
9. If some is giving Breast Feeding than try complete wean off after 6th month.