Maternal health –if the woman is HIV positive it is preferable that she has a healthy CD4 count before planning a pregnancy

Both partners’ HIV positive status –  sero-different couples need to understand the risks and benefits of different choices of conception.

The prognosis for her own health and the baby is good

The risk of the baby being infected is, with proper management, low

She will be managed by a multi-professional team who are experienced in caring for HIV positive pregnant women.

Support from GUM team, named HIV Consultant in Obstetrics, Antenatal Screening co-ordinator

Maternal viral load

Prolonged rupture of membranes

Mother presents late in pregnancy and is unaware of HIV status

In addition, chorioamnionitis, prolonged ROMs and premature birth have all been associated with MTCT of HIV and may be interlinked.

All the answers are correct:

Starting treatment at the right time

Tolerability

Adherence 

Answers 2, 3 4 and 5 are all correct.

A planned CS is performed at 38 weeks when the mother has a detectable viral load, is on AZT monotherapy,

It is the mother’s preferred choice of delivery or when there are obstetric indications.

Answers 1, 2, 4 and 5 are correct.

HIV exposure does not usually affect birth weight or clinical observations and otherwise well infants do not require admission to NNU

The baby will be tested at Day 1, 6 weeks, 12 weeks, 12 months, 18 months.

Neonatal post exposure prophylaxis (PEP) commenced as soon as possible after birth (ideally within 4 hrs)

Avoidance of breastfeeding is recommended in the UK

Answer 3 is incorrect: The neonate is tested for both HIV PCR and HIV antibodies. HIV positive antibody testing in an infant <18 months indicates maternal infection but does not diagnose HIV infection in the infant. Therefore the test result can be a false positive. If PCR continues to remain negative at 3 months there is a >95% chance of being uninfected but final confirmation is not usually given until 12 or 18 months.