Prevention Mother To Child Transmission of HIV (PMTCT) dr. Femmy Tambajong,SpA Manado, 30 Maret 2011

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 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 ASI : makanan terbaik BAYI DARI IBU HIV 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 to HIV+ women 45 40 35 30 25 20 15 10 5 0 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

ARV for baby Zidovudine Drug Dose - 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 weeks 2 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 Nevirapine 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 Infant AZT starting at 28 weeks of pregnancy or as soon as feasible Sd-NVPb + AZT/3TC AZT/3TC 7 days 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 US recommendation: AZT for 6 weeks WHO, 2006 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

Vaccine WHO/UNICEF ACIP Asymptomatic Symptomatic HIV + BCG Yes (birth) No No DPT Yes ( 6,10,14 weeks) Oral Polio Yes (0,6,10,14 weeks) Measles Yes (6 & 9 months) Immunizations recommendations Yes Yes (acellular P) Yes Yes Hepatitis B Yes Yes Yes Pneumococcus - - Yes Hib - - Yes Meningococcus - - Yes No (IPV) Yes, if CD4>15% 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 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 Hb/Ht Imunisasi sesuai jadwal IDAI/Depkes Perhatian khusus: BCG 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