Which drug is recommended for prevention of mother to child transmission of HIV infection ?
Correct Answer: Nevirapine
Description: A in special situations (Pregnancy) Nevirapine is the drug that prevents mother to child transmission . All pregnant women should have HIV testing at an early stage in pregnancy. The CD4 count falls by about 25% during pregnancy due to haemodilution. The course of HIV disease progression is not altered by pregnancy. In the pre-A era, the rate of mother-to-child transmission was 15-40%, with rates being influenced by several factors .A has dramatically reduced the risk of mother-to-child transmission of HIV to less than 1%. All pregnant women should sta A at the beginning of the second trimester, unless they have advanced disease, when A should be staed in the first trimester. Caesarean section is associated with a lower risk of mother- to-child transmission than vaginal delivery, but the mode of delivery does not affect transmission risk if the viral load is suppressed on A. HIV is also transmitted by breastfeeding. In high-income countries, exclusive formula feeding is generally recommended. In resource-poor settings, however, formula feeding is associated with a risk of infant morbidity and moality, which may negate the benefit of not transmitting HIV to the infant. There is minimal risk of transmitting HIV by breastfeeding in women with a suppressed viral load on A. Fuhermore, providing antiretrovirals to infants (usually nevirapine monotherapy) while they are breastfeeding has been shown to reduce the risk of transmission. Breastfeeding is therefore now encouraged in resource-poor settings. Infants should be exclusively breastfed for the first 6 months, as mixed feeding (with formula or solids) is associated with a higher risk of transmission. Diagnosis of HIV in infancy requires the detection of HIV RNA by PCR, as maternal antibodies to HIV, which persist for up to 15 months, will give a false-positive result on antibody assays. PCR should ideally be carried out within 6 weeks of bih to facilitate early A initiation. If the baby is breastfed, the PCR should be repeated 2 weeks after weaning. Ref Harrison 20th edition pg 879
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