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Checklist for HIV Positive Patient

CHECKLIST FOR HIV POSITIVE PREGNANT PATIENT

  • 1st prenatal visit
  • Education (see guideline)
  •  Ask patient about tolerance to medications to assess compliance
  • Labs (collect or review)
    1. Prenatal panel
    2. CBC w/ differential
    3. CMP
    4. Mg/P04
    5. Lipase, GGT, G6PD level, Hgb A1C
    6. HLA-B 5701 (to determine eligibility for abacavir)
    7. PPD (no controls)
    8. Full hepatitis panel (A, B and C)
    9. Toxoplasma IgG
    10. HIV Genotype
    11. CD4 count, HIV viral load
    12.  Ultrasound to confirm dates/viability
  • Refer to ID if not already done
  • Social services consult

Subsequent Outpatient Visits

  •  Review ID notes, labs
  •  If CD4 <200 – Bactrim DS, 1q day, unless G6PD deficient (PJP prophylaxis)
  •  If CD4<50 – Bactrim DS, 1q day AND Azithromycin 1200mg/day (MAI prophylaxis)
  •  Contraception counseling
  •  Ask about tolerance to meds
  •  If on a protease inhibitor, consider early diabetes screening
  •  Provide vaccines as needed (Pneumococcal, Hep A and B, Influenza)

34-36 weeks

  •  Education (see guideline)
  •  Evaluate viral load for delivery planning (see below, “intrapartum”)

Intrapartum

  •  Viral load <1000 copies/ml – await spontaneous labor, or C/S for OB indications
  •  Viral load >1000 copies/ml, no labor or ROM – Elective C/S by 38 weeks
  •  Viral load >1000 copies/ml, with labor or ROM – Individualize care (see guideline)
  •  Zidovudine (ZDV) 2mg/kg/hr IV loading dose, followed by 1mg/kg/hr drip until cord clamp regardless of viral load or mode of delivery.  At least 3 hours of ZDV infusion prior to delivery is ideal.
  •  Continue all ART meds throughout labor
  •  Delay AROM; Avoid FSE and assisted delivery
  • Notify Pediatrics
  •  Epidural not contraindicated
  • Breastfeeding contraindicated

Unknown HIV Status In Labor

  •  Expedited HIV testing (opt-out)
  •  If prelim result is positive:
  • IV ZDV (see above)
  • Confirmatory testing
  • Notify Peds

Postpartum Care

  • Continue ART regimen
  • Social Services
  • Education (see guideline)

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