Thailand New National Guideline
for PMTCT 2010
Suchat Hongsiriwon , MD
Department of Pediatrics
Chonburi Hospital
Regimen for pregnant women
who never received ARV
CD4 count
cells/cu.mm
ARV
regimen
duration of ARV
start
off
≤ 350
AZT+ 3TC+ LPV/r rapidly
>350
•
AZT + 3TC +LPV/r GA14wk off all ARV
continue
ARV as
guideline
Special conditions
1. In case of who got ARV before Pregnancy
check CD4 & VL
VL undetectable O.K
VL ≥ 1,000 c/ml consult AIDS experts for proper
regimen to suppress VL at undetectable
2.Poor or not good adherence : suitable regimen
3.Who got ARV < 4 wks : elective c/s
& HARRT in newborn as who has no ANC
In labor
continue ARV during pregnancy Plus
AZT300 q 3h or AZT600mg SD even through R to AZT
in order to adequate level in NB for PMTCT
No SD NVP given except who on AZT monotherapy
Beware to avoid of ergot eg. Methergin
(use oxytocin) due to LPV or EFV usage may
induce severe vasoconstriction
Pregnant who no ANC during labor
Pregnant who just know HIV+ve during Labor
sd NVP rapidly + AZT 300 mg q 3h until labor
Post partum AZT + 3TC + LPV/r until know CD4 result
If CD4 > 350 continue ARV 4wks then stop all
CD4 ≤ 350 change to adult guideline /consult Med
If expected that being labor within 2hr not give sd NVP
but continue AZT 300mg q 3h or sdAZT600mg
then start ARV later according to Thai adult guideline
C/S after ARV > 2h can reduce PMTCT
ARV for experienced sdNVP mother
ART for experience sdNVP exposed pregnant
AZT + 3TC + LPV/r all immune status
because of high risk of NVP resistance virus
PEP for Newborn : maternal no ANC
Start ARV as fast as possible: AZT + 3TC + NVP
AZT syr 4mg/kg/dose q 12 h 4-6wks
3TC syr 2mg/kg/dose q 12 h 4-6wks
NVP syr 4mg/kg q 24 h 2-4 wks
Stop AZT & 3TC after stop NVP 2 wks
Recommend start ARV in NB at age ≤ 48 h
Guideline for Dx HIV infection in Children2010
age<12mo
age12 -18 mo infected
1st DNA PCR > 1mo
1st anti HIV
+ve
+ve
repeat 2-4wk
-ve
age 4mo
+ve
-ve
infected
not infected
In-concordant
repeated 3rd DNA rapidly
In age ≥ 18 mo 2x Anti HIV test
-ve
2nd antiHIV at age 18mo
+ve
-ve
infected
not infected
In-concordant
repeated antiHIV at age 18 mo
HIV infection in infant who was born
from maternal HIV +ve at CBH
Budget year
2550
No.of infant
56
No. of HIV test
31
No. HIV +ve
1
MTCT rate
3.33%
No.of lost to FU 25
44.6%
2551
2552
2553
52
50
48
37
39
39
2
2
1
5.40% 5.12% 2.56%
15
11
28.94% 22%
9
18.75%
©Oct 53 – Feb 54 29 cases FU 21 Result negative all
Reference
1.แนวทางการตรวจและการดูแลรักษาผู้ตดิ เชือ้ เอชไอวีและ
ผู้ป่วยเอดส์ ระดับชาติ ปี พ.ศ. 2553
National Guidelines on HIV/AIDS
Diagnosis and Treatment: Thailand 2010
2.Data from Chonburi Hospital, Pediatrics OPD
from Oct -Feb 2011