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close this bookNational Guidelines for the Clinical Management of HIV/AIDS - Tanzania (NACP; 2005; 131 pages)
View the documentLIST OF ABBREVIATIONS
View the documentACKNOWLEDGEMENTS
View the documentFOREWORD
Open this folder and view contentsCHAPTER 1: INTRODUCTION
Open this folder and view contentsCHAPTER 2: ORGANIZATION OF HIV/AIDS CARE AND TREATMENT
Open this folder and view contentsCHAPTER 3: HIV/AIDS PREVENTION
Open this folder and view contentsCHAPTER 4: PROTECTIVE MEASURES AGAINST HIV TRANSMISSION
Open this folder and view contentsCHAPTER 5: LABORATORY TESTS IN HIV/AIDS
close this folderCHAPTER 6: HIV/AIDS AND PREGNANCY
View the document6.1 Introduction
View the document6.2 Mother to Child Transmission of HIV (MTCT)
View the document6.3 Prevention of Mother to Child Transmission of HIV (PMTCT)
Open this folder and view contents6.4 Antenatal care of women with HIV/AIDS
Open this folder and view contentsCHAPTER 7: PEDIATRIC HIV/AIDS AND RELATED CONDITIONS
Open this folder and view contentsCHAPTER 8: COMMUNITY AND HOME BASED CARE FOR PEOPLE LIVING WITH HIV/AIDS (PLHA)
Open this folder and view contentsCHAPTER 9: COUNSELLING RELATED TO HIV-TESTING AND TREATMENT ADHERENCE
Open this folder and view contentsCHAPTER 10: MANAGEMENT OF COMMON SYMPTOMS AND OPPORTUNISTIC INFECTIONS IN HIV/AIDS
Open this folder and view contentsCHAPTER 11: MANAGEMENT OF MENTAL HEALTH PROBLEMS IN HIV/AIDS
Open this folder and view contentsCHAPTER 12: MANAGEMENT OF HIV INFECTED PATIENTS USING ANTIRETROVIRAL DRUGS
Open this folder and view contentsCHAPTER 13: ARV THERAPY IN INFANTS AND CHILDREN
Open this folder and view contentsCHAPTER 14: USE OF ARVS IN SPECIAL CIRCUMSTANCES
Open this folder and view contentsCHAPTER 15: HIV/AIDS AND NUTRITION
Open this folder and view contentsCHAPTER 16: MANAGEMENT OF ANTIRETROVIRAL MEDICINES
Open this folder and view contentsCHAPTER 17: CERTIFICATION OF HEALTHCARE FACILITIES AS CARE AND TREATMENT SITES
 

6.2 Mother to Child Transmission of HIV (MTCT)

The risk of MTCT is estimated at 15 - 40% in developing world. Transmission of HIV from mother to child is the cause of over 90% of all HIV infection in children aged below 15 years. It is estimated that MTCT is the cause of about 72,000 infected children in Tanzania annually (using year 2000 data).

Available data in Tanzania shows that the risk of transmission is about 40%, generally distributed as follows:

10% in utero

20% during labour and delivery

10% through breast-feeding

Table 7: Estimated Risk and Timing of Mother-To-Child Transmission (MTCT) in the absence of interventions

Timing

Transmission rate

During pregnancy

5-10%

During labour and delivery

10-15%

During breastfeeding

5-20%

*Overall without breastfeeding

15-25%

*Overall with breastfeeding to 6 months

20-35%

*Overall with breastfeeding to 18 to 24 months

30-45%

* Includes risks rates during pregnancy, labour and delivery


Several factors have been shown to be associated with an increased MTCT of HIV, these include:

Viral factors

High levels of maternal viral load are associated with increased transmission.

Transmission rates have been shown to differ in different subtypes e.g. subtype C is associated with high MTCT of HIV compared to subtype A, B and D.

Maternal Factors.

Primary HIV infection during pregnancy.

Unprotected sex during pregnancy and lactation may lead to maternal re-infection.

Poor maternal nutrition.

Presence of abruptio-placenta or chorioamnionities.

Maternal disease stage: advanced stage of AIDS is associated with increased risk of HIV transmission.

Presence of other maternal infection during pregnancy and delivery e.g. STIs such as syphilis, chancroid and bacterial vaginosis.

Obstetric Factors

Mode of delivery; elective caesarean section reduces transmission risks.

Intra-partum haemorrhage is associated with increased HIV transmission to the infant.

Obstetric procedures e.g early rupture of membranes, episiotomies, vacuum delivery and forceps delivery increase the risk of MTCT of HIV.

Foetal factors

Pre maturity

Genetic susceptibility

Twin pregnancy

Postnatal Factors

Breast conditions (mastitis, breast abscess, nipple cracks).

Pattern of infant feeding (prolonged breast feeding, mixed feeding).

Infant infections (e.g. oral thrush, gastritis).

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