OG12.7 | HIV in Pregnancy — Summary & Reflection

KEY TAKEAWAYS

HIV in pregnancy is managed through India's NACO PPTCT programme, which has the potential to reduce mother-to-child transmission below 2%. Screening: universal opt-out HIV testing at ANC; ICTC confirmation by sequential RDT algorithm. Treatment: Option B+ — all HIV-positive pregnant women start lifelong TDF+3TC+EFV regardless of CD4 count; goal is undetectable viral load. Delivery: guided by viral load at 36 weeks — VL <1,000 copies/mL allows vaginal delivery; VL ≥1,000 or unknown → elective LSCS at 38 weeks. Infant prophylaxis: NVP for 6 weeks (standard/low-risk); NVP+AZT for 12 weeks (high-risk: no maternal ART, VL ≥1,000, or breastfed with unknown VL). Infant diagnosis: HIV DNA PCR at 6 weeks (NOT serology — maternal antibodies persist 12–18 months). Feeding: if AFASS criteria met → exclusive replacement feeding; if NOT AFASS (most Indian settings) → exclusive breastfeeding + maternal ART (VL <1,000) + NVP prophylaxis; NEVER mixed feeding. ART is lifelong for the mother after delivery.

REFLECT

Reflect on the tension you will face as a clinician: you are caring for a woman who feels entirely well and who may not yet have told her family about her HIV status. She is asking you — quietly, in a busy antenatal clinic — what she should do about feeding her baby. Kolb's experiential learning asks you to move from abstract concept to personal meaning: How would you counsel her so that she feels empowered rather than stigmatised? What assumptions about 'choice' in infant feeding do you carry, and how might those assumptions harm women who cannot safely formula-feed? What systemic barriers — clean water, ART supply chain, stigma — determine whether PPTCT achieves its 2% transmission target in your region? Reflect on what a truly equitable PPTCT programme would look like, and what role you as a clinician can play beyond simply prescribing TDF+3TC+EFV.