Based on the current NACO guidelines for prevention of parent to child transmission of HIV in India. Also describes the medication, testing and followup of children born to HIV positive mothers.

1. Perinatal HIV &
Prevention of Parent to Child
Transmission (PPTCT) in India
DR. Yusuf Imran
MD
J.N Medical College, AMU
Aligarh, India

2. Treatment
Perinatal HIV (NACO Guidelines- Dec 2013
 In the absence of any intervention the risk of perinatal transmission is 15-30% in non-breastfeeding
populations.
 Breastfeeding by an infected mother increases the risk by 5-20% to a total of 20-45%.
 Transmission can be reduced to under 2% by interventions (ARV prophylaxis to mother and neonate-elective
cesarian-complete avoidance of breastfeeding).
 However, in view of emerging evidence national guidelines recommend cesarian section only for obstetric
indications.
 All instrumentation (forceps/vaccum/episiotomy/artificial rupture of membranes/PV etc.) should be avoided
during labor and suctioning is done only for meconium stained babies.

3. Treatment
Perinatal HIV (NACO Guidelines- Dec 2013
 ARV regime for pregnant women
o All pregnant women detected positive for HIV during any trimester of pregnancy or lactation should be
started on lifelong ART irrespective of disease stage or CD4 counts.
o Preferred regimen- Tenofovir 300mg + Lamivudine 300mg + Efavirenz 600mg
o Alternate regimens- Azathioprine+lamivudine+Efavirenz, Azathioprine+Lamivudine+Nevirapine,
Tenofovir+lamivudine+Nevirapine.
o Pregnant women already on ART should continue lifelong on whatever regimen they are stabilised on.

4. Treatment
Perinatal HIV (NACO Guidelines- Dec 2013
 ARV regime for infants born to HIV+ mothers
o If mother received ART adequately in the antenatal period- Daily Nevirapine prophylaxis for 6 weeks.
o If mother has not received ART or Received ART for less than 24 weeks- Daily Nevirapine prophylaxis for 12
weeks.

5. Dose and duration of Nevirapine prophylaxis (HIV-1 infection)
* Give first dose of NVP within 6-12 hours of delivery

7. Treatment
Perinatal HIV (NACO Guidelines- Dec 2013
 Breastfeeding
o Factors that increase likelihood of transmission include detectable levels of HIV in breast milk, mastitis, low
maternal CD4 count.
o Start mother on ART (if not started earlier), as this reduces chances of transmission through breastfeeding.
o According to updated PPTCT guidelines (NACO) in India, infants should be given exclusive breastfeeding for
the first 6 months followed by complementary feeding.
o Support breastfeeding for a minimum of 6 months and continue breast feeding in addition to complementary
feeds for 1 year. At 1 yr stop breastfeeding gradually within 1 month.

8. Treatment
Perinatal HIV (NACO Guidelines- Dec 2013
 Breastfeeding cont…
o Exclusive replacement feeds may be started if mother has died or has terminal illness or decides not to
breastfeed despite adequate counselling.
o In such case commercial formula milk is given when AFASS (Affordable, Feasible, Sustainable and Safe) criteria
is met.
o Mixed feeding (breastfeeding + replacement feeds) should not be given in the first 6 months.

9. Treatment
Perinatal HIV (NACO Guidelines- Dec 2013
 Postnatal Diagnosis of HIV Infection
Flowchart on next slide…

10. Not detected

12. Treatment
Perinatal HIV (NACO Guidelines- Dec 2013
 Cotrimoxazole prophylaxis
o It is recommended for all HIV exposed children under age 18 months starting at 4-6 weeks of age and
continued until HIV infection can be excluded.
o Cotrimox prophylaxis is also recommended for breastfeeding child of any age until HIV infection can be
excluded (by testing after >6 weeks of stopping breastfeeding).
o In children of less than 6 months dose is 2.5 ml once a day (Syrup trimethoprim 40 mg and
sulphamethoxazole 200mg/5ml).

13. Treatment
Perinatal HIV (NACO Guidelines- Dec 2013
 Immunization
o HIV exposed or infected but asymptomatic children should receive all standard vaccines as per national
schedule.
o HIV infected children with immune suppression or symptoms should receive all standard vaccines except BCG,
OPV and Varicella vaccines.
o Consider HiB and Pneumococcal vaccines in all HIV exposed children irrespective of symptoms or CD4 count.