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Preventing Perinatal HIV Transmission: The Role of WIC

Preventing Perinatal HIV Transmission: The Role of WIC. François-Xavier Bagnoud Center University of Medicine & Dentistry of New Jersey. Objectives. Describe the current HIV epidemic in child-bearing women in the U.S.

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Preventing Perinatal HIV Transmission: The Role of WIC

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  1. Preventing Perinatal HIV Transmission: The Role of WIC François-Xavier Bagnoud Center University of Medicine & Dentistry of New Jersey

  2. Objectives • Describe the current HIV epidemic in child-bearing women in the U.S. • Review national recommendations for the prevention of perinatal HIV transmission • Describe the WIC nutritionist's role in supporting HIV positive women

  3. Facts about HIV • 1.2 million people living with HIV in the U.S. • 1 in 5 do not know they are infected • 50,000 people are newly infected each year • Medical therapies can help people • Lead longer, healthier lives • Reduce the risk of transmission

  4. Women and HIV in the US • 1 in 139 women will be diagnosed with HIV in her lifetime • Top 10 leading cause of death • Black females 10-54 • Hispanic females 15-54 • Most common methods of infection • Heterosexual contact • Injection drug use

  5. From: http://www.cdc.gov/hiv/topics/surveillance/resources/slides/index.htm

  6. From: http://www.cdc.gov/hiv/topics/surveillance/resources/slides/index.htm

  7. From: http://www.cdc.gov/hiv/topics/surveillance/resources/slides/index.htm

  8. Perinatal HIV Transmission Definition: HIV transmission from mother to infant during pregnancy, labor and delivery, or breastfeeding.

  9. Perinatal HIV Transmission • Without interventions, the risk of infection of the child is • 25% in non-breastfeeding populations, and • 40% in breastfeeding populations. • Can be reduced to less than 2% with antiretroviral (ARV) treatment and special care • 100-200 infants infected annually in the US • Peak of 1,650 infants infected in 1991

  10. Preventing Perinatal HIV Transmission • HIV testing • Treatment of HIV infection • Antepartum (during pregnancy) • Intrapartum (during labor and delivery) • Neonatal (for the newborn) • Avoidance of breastfeeding

  11. HIV Testing Recommendations • Universal Opt-Out Screening • HIV testing should occur as a routine part of prenatal care unless the woman declines • Pregnant women should receive oral or written information about HIV infection and transmission • No written documentation of informed consent should be required • Reasons for declining an HIV test should be explored but she may not be forced or coerced into taking the test.

  12. HIV Testing Recommendations • HIV screening prior to conception • All pregnant women screened on an opt-out basis • As soon as possible during pregnancy • During third trimester • Women in high incidence areas • Women at high risk • Women with signs and symptoms of infection

  13. HIV Testing Recommendations • Women at High Risk • IV drug users • Women who exchange sex for money or drugs • Women whose partners are HIV infected • Women who have new or multiple sex partners during pregnancy

  14. Symptoms of Acute HIV Infection • Two thirds of patients infected with HIV develop symptoms of acute HIV infection • Fever (80-90%) • Headache • Rash • Muscle aches • Sore throat • Fatigue • Swollen lymph nodes • Ulcers in mouth

  15. HIV Testing Recommendations • Rapid HIV testing should be performed on all women with undocumented HIV status during labor and delivery • All babies born to mothers with undocumented HIV status should be tested immediately after birth

  16. From: http://www.cdc.gov/hiv/topics/surveillance/resources/slides/index.htm

  17. Barriers to HIV Testing • Provider Barriers • Late or no prenatal care • Language barriers • Patient perceived as “low risk” • Lack of time for counseling and testing • State regulations regarding consent • Patient Barriers • Fear of result • Fear of partner violence or discrimination • Having tested negative in the past

  18. Antiretroviral (ARV) Prophylaxis • Antiretroviral drugs reduce perinatal HIV transmission by • Lowering maternal antepartum viral load • Providing pre- and post-exposure prophylaxis for the infant • Prophylaxis is recommended • Antepartum • Intrapartum • Neonatal

  19. ARV Prophylaxis for HIV+ Pregnant Women • Antepartum • Combination ARV treatment should be given to all HIV+ pregnant women • Intrapartum • IV zidovudine should be given to all HIV+ pregnant women during labor • Neonatal • ARV drug treatment should be given to all infants born to HIV positive mothers and continued for 6 weeks after delivery.

  20. From: http://www.cdc.gov/hiv/topics/surveillance/resources/slides/index.htm

  21. Breastfeeding and HIV • HIV positive women should not breastfeed • HIV is detectable during entire period of milk production • HIV may be transmitted through breast milk regardless of effective ARV therapy or viral load

  22. Breastfeeding and HIV • Chance of HIV transmission is increased if mother becomes infected with HIV while breastfeeding • Counsel high risk women on importance of HIV prevention and testing

  23. Premastication • Definition: practice of chewing food before feeding to a child • Approximately 14% of US caregivers engage in the practice • More common in Black population and younger caregivers

  24. Premastication and HIV • Can transmit HIV through blood in the saliva • Identified as cause of 3 pediatric HIV cases in 2008 • Can transmit other infections • Hepatitis B • Group A Streptococcus • Counsel clients against the practice

  25. HIV and Nutrition • Healthy nutrition is a good foundation • Diet rich in fruits, vegetables, whole grains, legumes, and lean protein • Counseling regarding food handling and avoidance of foodborne illness

  26. HIV and Nutrition • Tips for a healthy diet • 3 cups of fruits and vegetables daily in a variety of colors • Half of carbohydrates from whole grains • Lean meats and low-fat diary products • One serving of nuts, seeds, or legumes daily • Limit sugar, sweets, and soft drinks • Incorporate protein, carbohydrates, and some fat into all meals and snacks

  27. HIV and Common Nutrition Problems • Weight Loss • Early identification and referral • Add calories without bulk • Eat more frequently • Diarrhea • Increase soluble fiber; decrease insoluble fiber • Avoid intestinal irritants and stimulants • Decrease dietary fiber • Increase fluids and electrolytes

  28. HIV and Common Nutrition Problems • Nausea • Small, frequent meals • Dry snack food • Cool, clear beverages, popsicles • Avoid fried, sweet, spicy, odorous foods • Loss of appetite • Rely on favorite foods • Eat before bedtime • Try light exercise

  29. Common HIV Comorbidities • HIV infection and ARV therapy is associated with comorbid diseases that require nutritional intervention • Dyslipidemia • Coronary Heart Disease • Hyperglycemia • Renal disease

  30. WIC Policy #99-01 Contraindications to Breastfeeding • USDA WIC Policy #99-01 Contraindications to Breastfeeding strongly recommends that WIC staff: • Advise pregnant women to know their HIV status; • Provide local referrals to HIV counseling and testing services; and • Advise women not to breastfeed if they are HIV positive. • Additionally, an HIV positive woman should be referred to local HIV medical treatment services to protect her health (i.e. delay HIV disease progression) and prevent/reduce transmission of HIV to the child.

  31. WIC Nutrition Risk • Requiring nutrition risk as an eligibility criterion is a unique feature of the WIC Program. • In addition to meeting categorical, income, and residency requirements, each WIC applicant must be determined to be at nutrition risk on the basis of a medical or nutrition assessment by a physician, nutritionist, dietitian, nurse, or some other competent professional authority (CPA) in order to be certified as a WIC participant. • Nutrition risk criteria have been developed to assist local agency staff in determining Program eligibility.

  32. WIC Nutrition Risk: 352 Infectious Diseases • WIC Nutrition Risk 352 Infectious Diseases indicates HIV and AIDS as diseases that determine a WIC participant to be at nutrition risk. • It also states that breastfeeding is contraindicated for women with HIV or AIDS

  33. Nutrition Resources • Healthcare and HIV: Nutritional Guide for Providers and Clients • www.Nutrition.gov • www.choosemyplate.gov • www.eatright.org • http://www.tufts.edu/med/nutrition-infection/hiv/health.html

  34. References • Centers for Disease Control and Prevention. (2011, August 10). HIV among Women. Retrieved from http://www.cdc.gov/hiv/topics/women/index.htm • Centers for Disease Control and Prevention. (2011, May 20). HIV Surveillance in Women [Power Point Slides]. Retrieved from http://www.cdc.gov/hiv/topics/surveillance/resources/slides/women/index.htm • Centers for Disease Control and Prevention. (2007, October 16). Mother-to-Child (Perinatal) HIV Transmission and Prevention. Retrieved from http://www.cdc.gov/hiv/topics/perinatal/resources/factsheets/perinatal.htm • Centers for Disease Control and Prevention. (2011, December). New Hope for Stopping HIV: Testing and Medical Care Save Lives. Vital Signs. Retrieved from http://www.cdc.gov/vitalsigns/HIVtesting/index.html. • Centers for Disease Control and Prevention. (2011, July 14). Pediatric HIV Surveillance (through 2009) [Power Point Slides]. Retrieved from http://www.cdc.gov/hiv/topics/surveillance/resources/slides/pediatric/index.htm • Centers for Disease Control and Prevention. (2011 March 11). Premastication of Food by Caregivers of HIV-Exposed Children — Nine U.S. Sites, 2009–2010. MMWRWeekly Report, 60 (9), 273-275. • Centers for Disease Control and Prevention. (2006). Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health Care Settings. MMWR, 55 (No. RR-14), 1-17.

  35. Coffey, S. (2011). Guide for HIV/AIDS Clinical Care, (Ed.). Rockville, MD: U.S. Department of Health and Human Services Health Resources and Services Administration HIV/AIDS Bureau. • Ioannidis, J.P., et al. (2001). Perinatal transmission of human immunodeficiency virus type 1 by pregnant women with RNA virus loads <1000 copies/ml. J Infect Dis., 183 (4), 539-45. • Kilewo, C., et al. (2009). Prevention of mother-to-child transmission of HIV-1 through breastfeeding by treating mothers with triple antiretroviral therapy in Dar as Salaam, Tanzania: the Mitra Plus study. J Acquire Immune DeficSyndr, 52 (3), 406-16. • Panel on Treatment of HIV-Infected Pregnant Women and Prevention of Perinatal Transmission. (2011, September 14). Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States. Retrieved from http://aidsinfo.nih.gov/ContentFiles/PerinatalGL.pdf.   • Van de Perre, P., et al. (1991). Postnatal transmission of human immunodeficiency virus type 1 from mother to infant. A prospective cohort study in Kigali, Rwanda. N Engl J Med, 325 (9), 593-8. • U.S. Department of Health and Human Services. (2010, November 2). Nutrition & Food Safety. Retrieved from http://www.aids.gov/hiv-aids-basics/staying-healthy-with-hiv-aids/taking-care-of-yourself/nutrition-and-food-safety/ • Woods, M, Potts, E, and Connors, J. (2010, November 4). Building a High Quality Diet. Retrieved from http://www.tufts.edu/med/nutrition-infection/hiv/health_high_quality_diet.html

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