PREVENT TRANSMISSION OF HIV/AIDS PREGNANT WOMEN : LITERATUR REVIEW *Nunung Nurhayati STIKep PPNI Jawa Barat, Bandung, West Java Indonesia Email: nunky_adzra@yahoo.com ABSTRACT Baby risk be infected HIV/AIDS by his mother with HIV/AIDS during pregnancy, childbirth and lactation. There has been increasing the number of pregnant woman with HIV/AIDS every year. When without treatment antiretroviral, about 15-30 % of infants born of mother with HIV/AIDS will infected during pregnancy and childbirth, and add from 5-20 % will infected when breastfeeding (WHO, 2012). A method of writing through literature the search using google search and then search to ebscohost then entered link CINALH and PROQUEST web site. Keywords used HIV/AIDS, pregnant, and prevention. Four publications were analyzed. Design research using RCT, publication of the journal the last 10 years (2007-2017). Antiretroviral treatment (ART) recommended of WHO for a mother who is infected with HIV/AIDS during pregnancy, childbirth and postpartum to prevent the process of HIV/AIDS transmission from mother to baby. Generally 3 antiretroviral with a combination for mother undergo pregnancy, avoid providing breastfeeding, and with the process of birth by section of elective cæsarea have reduced transmission < 2 %. During which the mother undergo pregnancy, mother with HIV/AIDS from the age of pregnancy 24 weeks have received ARV (Zidovudin (ZDV), Lamivudine (3TC), and Nevirapine (NVP)). Treatment continued during the labor and postnatal. Based on literature who writed review obtained the conclusion that the AZT for pregnant women with HIV/AIDS can reduce the risk of transmission. Keywords: HIV-AIDS, Pregnant, Transmission Introduction Children are an at risk population get HIV/AIDS, nine out of ten children with HIV/AIDS infected through mother with HIV/AIDS during pregnancy, delivery and lactation (UNAIDS, 2013). When without treatment antiretroviral, about 15-30 % babies born from mother with HIV/AIDS will be infected during pregnancy and childbirth, and more than 5-20 % will be infected when breastfeeding (WHO, 2012). Although prevalence of transmission HIV/AIDS infection from mother to child is still limited, but there is a tendency increase in the number of pregnant woman with HIV/AIDS. Projected there will be increased service needs prevent transmission of HIV/AIDS by mother to binfant (PMTCT) for pregnant women with HIV/AIDS would rise from 6730 people in 2012 be 9170 people in 2017 (KPAN, 2015 ). According to the UNITED NATIONS about 17 million women around the world between the ages of 15-49 years infected with HIV/AIDS (UNAIDS, 2013), HIV/AIDS can be transmitted from mother to baby during pregnancy, intranatal, postnatal through a process of lactation and is the main cause of death in Sub-Saharan Africa (Renaud, 2012). The majority of transmission HIV/AIDS from mother to their babies during delivery process can be prevented with the provision of therapy ARV for peri-partum. Southern asia and
Southeast asia reported around 270.000 children infected with HIV (WHO, 2012). The way transmission from mother to child identified very significant in asia. At the end of 2010 around 150,000 children in southern asia and southeast asia, and 8000 children in east asia living with HIV/AIDS, and they of infection in his mother (UNAIDS, 2013 ). This was possible because the scope of prevention of mother-to-child transmission (PMTCT) in asia very low. PMTCT is a program that made by WHO happened to prevent the spread from mother to child. However in 2008 in east asia, southern asia and southeast asia about 30 % of pregnant woman heve done HIV testing, show that there is a significant increase when compared with the 2012 that was only about 18 %. The percentage is still very low compared to other areas in the world as in eastern europe and central asia of 59 %, east africa and south 61 %, and latin america and karabia 61 % ( WHO, 2012). Indonesia is one of countries in asia who growth cases HIV and AIDS relatively fast, it is expressed by UNAIDS in a report HIV in the asia and the pacific getting to zero, in 2012. Indonesian ministry of health reported, since 1987, the total of AIDS cases of 26.483 cases with death cases 5.056 cases. AIDS cases reported for 2010 by ministry of health Indonesian have on the basis of sex, 80 % of cases in males and 19.5 % in women. From this data is clearly described the proportion of HIV case in women increased highly significant in a period of 6 years. The increase in data a very significant at a women group if they do not with an increase in the effort to reduce which means, so in 2015 estimation the total of AIDS case will be 400,000 people with 100.000 the that. In the 2020 be 1,000,000 people with 350,000 the death as reported by KPAN in the asian epidemic model. Most of the transmission of expected in subpopulasi risky and wife (or sexual partners other). In the same year expected to occur the transmission of HIV cumulatively in more than 38.500 children born of mother with HIV/AIDS. This situation shows that HIV and AIDS have to soon became great attention by the Indonesian government and will be a threat large when was not in balance to efforts to prevent and combat to handle it (IPPI, 2014). Method A method of writing through literature the search using google search and then search to ebscohost then entered link CINALH and PROQUEST web site. Keywords used HIV/AIDS, pregnant, and prevention. Four publications were analyzed. Design research using RCT, publication of the journal the last 10 years (2007-2017). Result Treatment antiretroviral (ART) recommended WHO for mother HIVinfected during pregnancy, childbirth and postpartum to prevent the process hiv transmission from mother to baby. According to Besigin, t. 2007. The process of transmission of HIV-1 is expected to be cause HIV on child is 90 %, with more than 700,000 children infected with HIV on 2016 around the world. Generally 3 antiretroviral by a combination given during which the mother undergo pregnancy, avoid providing breastfeeding, and with the process of birth by an elective section of cæsarea have reduced transmission < 2 %. During which the mother undergo the process of pregnancy, mother with HIV positive from the age of pregnancy 24 weeks have received ARV (zidovudin (ZDV), lamivudine 2
(3TC), and nevirapine (NVP)). Pregnant women with HIV/AIDS not included category HAART receiving treatment prophylactic: ZDV+3TC of gestational age 32 weeks until 3 days after mothers and get sdnvp during delivery, or get sczdv or sdnvp course or both from the age of pregnancy 28 week, all babies born and his mother with HIV positive get AZT syrups during 7 day and sdnvp syrup 3 day. According to Lorenzo, et. ( 2013 ). The transmission of HIV infection from mother to baby, when mother do not get therapy is 15-30 % in the mother who did not provide breastfeeding, and 20-45 % on the that gives breast-feeding. Granting ARVon third trimester pregnancy, during deliveries, and after birth can reduce the risk transmission of HIV from mother to baby about 2-4 % in the mother who did not provide breastfeeding. On granting ARV third trimester of pregnancy, during the delivery process, and after delivery can reduce the risk of transmission of HIV from mother to baby around 2-4 % in mothers who breastfed not give. The use of AZT regimen / lamivudine (3TC) plus nevirapine (NVP) during the third trimester on the mothers that give breastfeeding happened the contagion 6-15 %. Antiretroviral treatment proper process can reduce transmission from mother to baby < 1 % in 2010. Based on the american-french pediatric AIDS clinical trial group (PACTG) that granting zidovudine in pregnant mother and baby can reduce the risk of transmission of perinatal infections >70%. In 2010, pregnant mother infected with HIV in Denmark get oral ZDV of the age of 14 weeks of pregnancy, IV get ZDV during the delivery process and during neonatal get ZDV during six weeks after childbirth. In the 2013-2014, recommended granting ZDV to children to the age of 4 weeks. Since 1998, ART has been recommended for given to all pregnant women who is infected with HIV in Denmark. According to national guidelines, ART have to start given at a gestational age 14 weeks if the number of CD4 < 350 / mls of cells. For mother with CD4 4350 / mls of cells, ART must be given in the first trimester and third. Efavirenz to be avoided during the first trimester and replaced with an alternative other ART. Other study conducted by Besigin, T, et al. (2014). Study aims to assess the effectiveness of the provision of ART the short-term 4 weeks and long-term 12 weeks. Research methodology it uses design research observational cohort, population from the study is all pregnant women HIVinfected AIDS, having a baby, low income, enrolled in two antenatal clinic in the two districts from august 2013-april 2014. Mother were divided into two groups.the first that is pregnant women HIV-infected who are part category HAART ( highly active antiretroviral therapy ), group both the pregnant women HIV-infected not included HAART. A population of 261 pregnant women infected HIV-1 and 250 mother AEV during get pregnant and during childbirth : 143 people (57 %) get scarvs and 107 people (43 %) get regimen ART. The average age mother is 27 years with the age range of the 24-31 years, and the average age of pregnancy is 30 sunday by the span of 25-33 sunday. Median CD4 cells is 338 / mm3 by the span of CD4 cell 206-488 / mm3 and 44 people respectively 17.6% are part clinical stadium category 3 or 4. Mothers receiving ART conforming to standards of the who as many as 104 people, 3 a person is gaining ART adjusted policy doctor, median value CD4 cells is 189 / mm3 than 107 mothers receiving ART, 33 people (30.9%) from the mother are part stadium 3 or 4, and 58 people (54, %) owns CD4 > 200 / mm3 cells, 3
most of which is 102 people (95,3%) ZDV get the combination, 3TC, and NVP. Get art started at a gestational age 30 sunday with value median 27-33 sunday.long use art up to the mother gives birth is 74 day ( 48-91 the day, 91 % of mothers undergo adherence to treatment, all babies born of mother get art sdnvp syrup on the day 3rd and get zdv syrups during one week, pregnant mothers get scarvs is 143 people, with cd4 467 cells / mm3 by the span of 368-602 cells/mm3, 11 people (7.7%) are part hiv stadium 3. Median the gestational age is 34 weeks by 32-36 range weeks and the number of days the average get drug regimen scarvs is 46 days by the span of 31-65 day.103 mother (72,0%) that received ZDV + 3TC with sdnvp during childbirth, 26 people (18,2%) get sczdv with sdnvp, and 14 people (9.8%) get sdnvp course. Among 241 mother who has a bun, 172 people (71.3%) which directly give breastfeeding after the delivery process (62 people in the group that get arv and 110 people in the group that get scarvs). The average length of the provision of breastfeeding is 5.4 months by the span of (4,0-6,8) months and a little longer to a group who get the scarvs 5.8 months compared to the group that get art 4.6 months. As a whole, 231 of neonates at risk is infected with hiv is 172 people (75,1%) who began the provision of breastfeeding after the delivery process, 168 people tested hivnya at the age of 4 weeks. The status of hiv infection can be ascertained at 225 a child (97,4%), 12 of them baby diagnosed hiv infected : 5 baby diagnosed at the age of 4 weeks, 3 baby at the age of 3 months, baby and 4 at the age of 12 months. The probability is infected with HIV in the period was 2.2% peripartum in the group who get the ART and 3.1 % to a group who get the scarv. In infants the age of 12 months, 5.7 % of infants diagnosed is infected with HIV, 3.3% to a group who get the art and 7.5% in the group that get scarvs.the researchers found BBLR is one of the factors relating to HIV infection. The future research conducted by Linstow, et al. (2010). The purpose of this study is to record in national epidemiology pregnant women infected with HIV and the results for 14 years. A kind of this research using methods kohort retrospective, the population of research is all mother infected with HIV in Denmark. Gestational age mother 18-20 week, get ART from the age of pregnancy 26 week. The result of this research is from 210 mother HIV-infected with 255 pregnancy has given birth to the kids are 258 people. The provision of art started of gestational age 14 weeks in 42 mother of 235 pregnancy (17,9%), 3 mother of 49 pregnancy 6.1% in the 1994-1999 be 39 mother of 206 pregnancy (18.9%) in the 2000-2008. 7 % of mothers start treatment in a trimester third pregnancy and 19 mother (7.9%) have never get art, because status hiv not known before pregnant. Since 2000, only 7 mother (3.4%) did not receive art pregnancy, 3 mother experienced delays of the diagnosis and 2 mother refuse to seek treatment.in the middle of 1990 ZDV is therapy the most often used for preventing the contagion of from mother to child.in 1997 therapy combination used in some mother, in 2008 ART introduced and from 2000 almost all the mothers get ART. ART the most often used is ZDV + lamivudine, 3TC + lopinar + norvir, and ZDV + 3TC + nelfinavir. Almost 80 % of mothers continue to get art after the delivery process. In 209 of 231 childbirth, ZDV given during the process intranatal. CD4 the average before childbirth 214 of the birth of your 83,9 % and ranged from 55-1268 cells/ml. Mean last CD4 increased from 420 cells/ml in the 1994-1999 be 476 cells/ml in the 2000-4
2008. Than 214 pounds mother has CD4>200 sl/ml. Significantly mothers receiving art before the age of 14 week of pregnancy undetectable the RNA virus HIV the birth compared with mothers receiving ART > of the 14th week of the gestational age. Heavy born the average 3050 gr, 31 a baby from 231 infants (13.4%) have BBLR > 2500gr. APGAR scor in the first and 5th is 190 of 208 infants (91,3%). The same study by research above was also conducted by Gold, et al. (2014). The main purpose of this study is to find the outreach of the program prevent transmission of HIV from mother to the baby in the Busia Kenya from 1 january 2010-31 december 2012. This research in a description of intervention, the population of research is pregnant women who come to central health services during the visit first in Busia Kenya, between 1 january 2010-31 december 2012. The baby from mother HIV-infected the test is conducted twice, first at the age of six weeks, and tests the second after stop feeding for 6 weeks. Design this research using cross-sectional. Between 1 january 2010-31 of december 2012, 22.566 mother willing to tested HIV at the clinic ANC, 1668 mother the results HIV positive, so that prevalence of HIV 7.4 %. 1.036 mother of 1668 mother HIV positive 62% enroll in preventive programs the transmission of HIV from mother to infants and 632 other mothers not continuing. During the study is done is 767 babies born, in total are 673 couples infants and mothers receiving therapy to reduce the transmission of HIV, so that their scope 40,4% for pregnant women expressed HIV positive. Almost all the mothers, 99% delivery pervaginam and many mother is planning to give exclusive breastfeeding which is about 69 %. At the end of this research, of 1668 mother HIV-infected at the beginning identified, HIV final status after the process of giving breastfeeding of 309 baby (260 baby test results HIV negative and 49 baby test results HIV positive). The transmission of hiv from mother to infants after the process of giving breastfeeding is 15,86%. 767 newborns out of this research, 309 baby (40,2% ) can solve this research appropriate protocol, 28 infants (3,6%) died from 309 baby, 80 set (mother and babies) (25,9 %) has completed protocol, 205 infants (66,3%) completed only partially protocol and 24 infants (7,8%) did not receive intervention. Conclusion Treatment antiretroviral (ART) recommended WHO for mother infected with HIV during pregnancy, childbirth and postpartum to prevent the process HIV transmission from mother to baby. The risks of AIDS 4.6 times higher on mother and baby which receiving treatment some compared with mothers and babies with HIV receiving treatment complete and 43 times higher on the and babies with HIV not undergo treatment. Generally 3 antiretroviral with a combination given during which the mother undergo pregnancy, avoid providing breastfeeding, and with the process of birth by an elective section of cæsarea have reduced transmission < 2 %. During which the mother undergo the process of pregnancy, mother with HIV from the age of pregnancy 24 weeks have received ARV (zidovudin (ZDV), lamivudine (3TC), and nevirapine (NVP) ). Treatment continued during the labor and postnatal. Based on literature who writed review obtained the conclusion that the AZT for pregnant women with HIV/AIDS can reduce the risk of transmission. Reference 5
Besigin, T, et al. (2014). Antiretroviral treatment and prevention of peripartum and postnatal HIV transmission in west Africa : Evaluation of a two-tiered approach. PLoS Med. 2007 Aug; 4 (8): e257. Cavarelli, M., & Scarlatti, G. (2013). Human immunodeficiency virus type 1 mother-to-child transmission and prevention: successes and controversies. Journal of Medicine, 270, 561-579. Gold., B. T., Ekouevi, D. K., Viho, I., Bosse, C. A., Coffie, P. A., Rouet, F., et al. (2014). Antiretroviral treatment and prevention of peripartum and postnatal HIV transmission in West Africa: Evaluation of a two-tiered approach. Plos Medicine. 4 (8), 1362-1373. Hoffmann, C., Rockstroh, J. K., & Kamps, B. J. (2014). HIV medicine. World Health Organization: Hamburg. Linstow, M. L., Valerius, N. H., Rosenfeldt, V., Weis, N., Lebech, A. M., Storgaard, M., et al. (2010). Prevention of mother-to-child transmission of HIV in Denmark, 1994 2008. HIV Medicine. 11, 448 456. Lorenzo, A. A., Ferreyra, C., Alvarez, A., Palma, P. P., Velilla, E., & Amo, J. D. (2014). Effectiveness of a PMTCT programme in rural Western Kenya. AIDS Care, 23 (3), 274-280. UNAIDS. (2013). The risk of HIV transmission during breastfeeding a table of research findings. AIDSTAR One. World Health Organization. (2012). Rapid advice: Use of anti retro viral drugs for treating pregnant woman and preventing HIV infection in infants. WHO. 6