Preventing Perinatal HIV

Transmission: The Role of

WIC
Franois-Xavier Bagnoud
Center
University of Medicine &
Dentistry of New Jersey
1

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

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
3

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
4

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

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

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

Perinatal HIV Transmission

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

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

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

10

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.
11

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
12

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

13

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
14

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

15

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

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
17

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
18

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.
19

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

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

21

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

22

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

23

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

24

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

25

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
26

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
27

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
28

Common HIV Comorbidities

HIV infection and ARV therapy is
associated with comorbid diseases
that require nutritional intervention

Dyslipidemia
Coronary Heart Disease
Hyperglycemia
Renal disease

29

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.

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.

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

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/nutritioninfection/hiv/health.html
33

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, 20092010.
MMWR Weekly 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.

34

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 Defic Syndr, 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-withhiv-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/nutritioninfection/hiv/health_high_quality_diet.html

35