QUIZ : HIV/ PPTCT/ PEP

Dr Hariharan

Dr Jaiswal

Dr Dhawle

Round I: 4 questions 20 marks each Negative marks ( -5 for wrong answer) Transferrable Bonus marks 10.

1. What is the chance of antenatal transmission of HIV from the mother to the child?

Transmission rates in untreated non-breastfeeding populations in resource-rich countries range from 14–32%, compared with 25–48% among breastfeeding populations in resource poor settings.

HIV transmission from mother to child can occur antenatally (in utero), during the intrapartum period and postnatally (through breastfeeding).

The absolute risk of these modes of transmission has been estimated at 5–10%, 10–20% and 5–30%, respectively

2. Maternal antibodies to HIV persist in the baby upto how many months?

All infants born to HIV-positive mothers have serum HIV antibodies because of passive placental transfer, which persist up to 18 months of age; this does not indicate infection with the virus.

3. What is the most important factor affecting the mother to child transmission of HIV?

HIV viral load

There is a strong positive correlation between maternal antenatal viral load and the risk of both in utero and intrapartum transmission

Interventions to reduce maternal viral load reduce HIV

transmission risk.

4. what is the criteria for starting HAART in a HIV infected person?

The BHIVA and the WHO guidelines differentiate pregnant women into those who require HAART for their own health and those who do not

The threshold for starting lifelong HAART has been revised

to a CD4 count <350 cells/μl.

Round 2: PEP

4 questions 20 marks each Negative marks (- 5 for wrong answer) Transferrable Bonus marks 10

1. A resident in OBG accidentally spills a urine sample from a high viral load HIV positive mother. Should she receive PEP?

2 The same resident in the OT, receives a splash of amniotic fluid on her eyes, while her senior operates on a case of polyhydramnios (despitewearing goggles). What is her risk of having contacted HIV?

0.09% 9/10,000

3. A friend of this resident receives a needle prick injury while trying to cap the needle after sampling (despite wearing gloves). The woman is HIV neg but HBV positive. What are the chances of transmission of HBV after a needle stick injury?

The average risk of acquiring HIV infection after different types of occupational exposure is low compared to risk of infection with HBV or HCV.

In terms of occupational exposure the important routes are needle stick exposure

0.3% risk for HIV 9–30% for HBV 1–10% for HCV and mucous membrane exposure 0.09% for HIV

4. How should you wash the exposed area in case of a splash of amniotic fluid at normal delivery?

Soap and water Avoid antiseptics Do not scrub, just rinse

Round 3

Rapid fire 05 marks each 40 seconds. Max 6 questions No Negative marks Non transferrable

Team 1

1. true of false: cesarean section offers benefit over vaginal delivery in

women with undetectable viral loads 2. what is the most devastating side effect of HAART? 3. PEP should be given within ______ hours of exposure. 4. True or false: Self-insemination of partner’s semen is

recommended to

protect the uninfected male partner of an HIV-positive female and is

easily performed by the couple 5. What are Rapid HIV tests? 6. Minimum levels of transmission with ART/ LSCS/ Formula

feeding can

decrease the transmission levels to_________

Team 2

1. true of false: For women who do not require HIV treatment for their

own health, HAART should be initiated between 20 and 28 weeks and

discontinued at delivery. 2. what is the most important problem with single dose Nevirapine? 3. What additional immunization during pregnancy would you advise if

the

woman is HIV positive? 4. True or false: Sperm-washing is recommended to protect the

uninfected

female partner of an HIV-positive male 5. True or false: All women who are HIV positive are recommended to

have annual cervical cytology. 6. If an instrumental delivery is required in a woman delivering normally,

what would you choose? Forceps or Ventouse?

Team 3

1. True of false: HAART throughout pregnancy is associated with an

increased risk of teratogenicity 2. True or false: Co infection with HCV increases the transmission risk of

HIV irrespective of the mode of delivery 3. For it to be effective, PEP should atleast be given for a period

of________ days 4. True or false: Management of opportunistic infections is NOT altered

by

pregnancy. 5. True or false: Exclusive breast feeding is more dangerous than mixed

feeding 6. PCP prophylaxis should be initiated when the maternal CD4 counts

drop

below______

Team 4

1. true of false: HAART during pregnancy is associated with a

high risk of Prematurity. 2. what is the important obstetric side effect of Protease inhibitors? 3. Diagnosis of HIV can be made even during the window period

with

________ testing 4. True or false: VBAC can be considered in women with HIV in

pregnancy 5. When should an elective cesarean section be planned in a

mother

with HIV? 6. All neonates, delivering to HIV positive mothers should be

treated with

anti-retroviral therapy within _____ hours of birth.