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06/07/09 Dr.Sujnanendra Mishra Dr.Sujnanendra Mishra. M.D.(O&G)  Sub Divisional Hospital.  PATNAGARH.  BOLANGIR. PMTCT - - -  CAN IT BE  A THING OF PAST ?
06/07/09 Dr.Sujnanendra Mishra Welcome you  to this  brain storming session on HIV. CHIEF DISTRICT MEDICAL OFFICER & ASSOCIATES  BOLANGIR
06/07/09 Dr.Sujnanendra Mishra HIV  in INDIA
06/07/09 Dr.Sujnanendra Mishra
06/07/09 Dr.Sujnanendra Mishra Expanding Disease Burden 1986 to 2005
Mothers are always Targeted : 06/07/09 Dr.Sujnanendra Mishra “ Men Think  females Bring The Disease”
06/07/09 Dr.Sujnanendra Mishra Prevention of Parent- to- Child  Transmission   (“PPTCT”) (   generally known as “ PMTCT”) To be REPLACED BY
06/07/09 Dr.Sujnanendra Mishra Rationale for PPTCT in India 27 million pregnancies per year 1,89,000 infected pregnancies per year Cohort of 56,700-60,000 infected newborns per year 0.7% prevalence 30% transmission
HIV antibody Quantitative viral load Qualitative HIV DNA Absolute CD4+ cell count  High risk of progression Moderate risk of progression Low risk of progression Weeks of Infection 0  1  2  3  4  5  6  7  8  9  10  11  12  14  26 SCHEMATIC OF LABORATORY FINDINGS IN PRIMARY HIV INFECTION ACUTE RETROVIRAL SYNDROME
Transmission during Pregnancy Perinatal & Breastfeeding 06/07/09 Dr.Sujnanendra Mishra 0% 20% 40% 60% 80% 100% Early Antenatal (<36 wks) Late Antenatal (36 wks to labor) Labor and Delivery Late Postpartum (6-24 months) Early Postpartum (0-6 months) Proportion of infections
The route by which children  are infected with HIV ,[object Object],[object Object],06/07/09 Dr.Sujnanendra Mishra
The  frequency  of  perinatal HIV transmission ,[object Object],[object Object],[object Object],[object Object],06/07/09 Dr.Sujnanendra Mishra
The  frequency  of  perinatal HIV transmission ,[object Object],[object Object],[object Object],[object Object],06/07/09 Dr.Sujnanendra Mishra
The  frequency  of  perinatal HIV transmission ,[object Object],06/07/09 Dr.Sujnanendra Mishra
Perinatal HIV transmission risk factors ,[object Object],[object Object],[object Object],[object Object],06/07/09 Dr.Sujnanendra Mishra
Routes of mother-to-child transmission of HIV   in utero and  during  delivery   ,[object Object],[object Object],[object Object],[object Object],06/07/09 Dr.Sujnanendra Mishra
Perinatal HIV transmission risk factors ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],06/07/09 Dr.Sujnanendra Mishra
Perinatal HIV transmission risk factors ,[object Object],[object Object],[object Object],[object Object],06/07/09 Dr.Sujnanendra Mishra
Perinatal HIV transmission risk factors ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],06/07/09 Dr.Sujnanendra Mishra
Core provisions of the section &quot; Prevention of Mother-to-Child Transmission of HIV &quot; of the  WHO protocol for the CIS countries, March, 2004 . ,[object Object],[object Object],[object Object],[object Object],06/07/09 Dr.Sujnanendra Mishra
Core provisions of the section &quot; Prevention of Mother-to-Child Transmission of HIV &quot; of the  WHO protocol for the CIS countries, March, 2004. ,[object Object],[object Object],[object Object],06/07/09 Dr.Sujnanendra Mishra
Core provisions of the section &quot; Prevention of Mother-to-Child Transmission of HIV &quot; of the  WHO protocol for the CIS countries, March, 2004. ,[object Object],[object Object],06/07/09 Dr.Sujnanendra Mishra
Core provisions of the section  &quot; Prevention  of Mother-to-Child Transmission of HIV &quot; of the  WHO protocol for the CIS countries, March, 2004. ,[object Object],[object Object],06/07/09 Dr.Sujnanendra Mishra
Core provisions of the section &quot; Prevention of Mother-to-Child Transmission of HIV &quot; of the  WHO protocol for the CIS countries, March, 2004. ,[object Object],[object Object],06/07/09 Dr.Sujnanendra Mishra
The strategy for the prevention of mother-to-child transmission of HIV . ,[object Object],[object Object],[object Object],[object Object],06/07/09 Dr.Sujnanendra Mishra
Components of the prevention of mother-to-child transmission of HIV ,[object Object],[object Object],[object Object],06/07/09 Dr.Sujnanendra Mishra
  PMTCT  Feasibility Study    AZT: March 2000 - August 2001 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],06/07/09 Dr.Sujnanendra Mishra
HIV Glossary ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],06/07/09 Dr.Sujnanendra Mishra
06/07/09 Dr.Sujnanendra Mishra Four classes of ARV drugs approved
HIV REPLICATION 06/07/09 Dr.Sujnanendra Mishra
Overview of antiretroviral drugs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],06/07/09 Dr.Sujnanendra Mishra
Other ARVs for pMTCT? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],06/07/09 Dr.Sujnanendra Mishra NRTIs Nucleotide RTI Protease Inhibitors
The three-part regimen of prevention of perinatal HIV   transmission  by  zidovudine (PACTG Protocol 076  [ Pediatric AIDS Clinical Trials Group] ) ,[object Object],[object Object],[object Object],[object Object],06/07/09 Dr.Sujnanendra Mishra
The short-course zidovudine regimen of prevention of perinatal HIV transmission ,[object Object],[object Object],[object Object],[object Object],06/07/09 Dr.Sujnanendra Mishra
The  regimen of prevention of perinatal HIV   transmission  by  nevirapine ,[object Object],[object Object],[object Object],06/07/09 Dr.Sujnanendra Mishra
The  PETRA  regimen of prevention of perinatal HIV transmission ,[object Object],[object Object],[object Object],[object Object],[object Object],06/07/09 Dr.Sujnanendra Mishra
Prevention  regimen s using ARV drugs with a rate of  perinatal transmission below 2% ,[object Object],[object Object],[object Object],[object Object],06/07/09 Dr.Sujnanendra Mishra
Prevention of perinatal HIV transmission in the management of labor/delivery ,[object Object],[object Object],[object Object],06/07/09 Dr.Sujnanendra Mishra
Prevention of perinatal HIV transmission in the management of labor/delivery ,[object Object],[object Object],06/07/09 Dr.Sujnanendra Mishra
Clinical scenarios  for  prevention of  mother-to-child transmission of HIV (WHO  recommendations , March 2004) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],06/07/09 Dr.Sujnanendra Mishra
Clinical scenarios  for  prevention of  mother-to-child transmission of HIV (WHO  recommendations , March 2004) ,[object Object],[object Object],[object Object],[object Object],[object Object],06/07/09 Dr.Sujnanendra Mishra
Clinical scenarios  for  prevention of  mother-to-child transmission of HIV (WHO  recommendations , March 2004) ,[object Object],[object Object],[object Object],[object Object],[object Object],06/07/09 Dr.Sujnanendra Mishra
HAART  during   pregnancy ,[object Object],[object Object],[object Object],[object Object],06/07/09 Dr.Sujnanendra Mishra
Clinical scenarios  for  prevention of  mother-to-child transmission of HIV (WHO  recommendations , March 2004) ,[object Object],[object Object],[object Object],06/07/09 Dr.Sujnanendra Mishra
Prophylaxis in relation to the time of an HIV-infected woman's visit to a women's clinic or maternity hospital   ,[object Object],[object Object],[object Object],[object Object],06/07/09 Dr.Sujnanendra Mishra
Prophylaxis in relation to the time of an HIV-infected woman's visit to a women's clinic or maternity hospital   ,[object Object],[object Object],[object Object],[object Object],06/07/09 Dr.Sujnanendra Mishra
Prophylaxis in relation to the time of an HIV-infected woman's visit to a women's clinic or maternity hospital   ,[object Object],[object Object],[object Object],06/07/09 Dr.Sujnanendra Mishra
Prophylaxis in relation to the time of an HIV-infected woman's visit to a women's clinic or maternity hospital   ,[object Object],[object Object],[object Object],06/07/09 Dr.Sujnanendra Mishra
Contraindications to the prescription  of perinatal HIV prevention medicines ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],06/07/09 Dr.Sujnanendra Mishra
Prophylaxis in relation to the time of an HIV-infected woman's visit to a women's clinic or maternity hospital   ,[object Object],[object Object],06/07/09 Dr.Sujnanendra Mishra
Prevention of perinatal HIV   transmission  in  newborns ,[object Object],[object Object],[object Object],[object Object],06/07/09 Dr.Sujnanendra Mishra
Strategy for the  prevention of transmission of HIV  from nursing mother to child ,[object Object],[object Object],[object Object],[object Object],[object Object],06/07/09 Dr.Sujnanendra Mishra
HIV Testing for Infants ,[object Object],[object Object],[object Object],[object Object],06/07/09 Dr.Sujnanendra Mishra
HIV Testing for Infants ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],06/07/09 Dr.Sujnanendra Mishra
HIV Testing for Infants ,[object Object],[object Object],[object Object],[object Object],[object Object],06/07/09 Dr.Sujnanendra Mishra
HIV Testing for Infants ,[object Object],[object Object],[object Object],[object Object],[object Object],06/07/09 Dr.Sujnanendra Mishra
Rapid Testing in Labor ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],06/07/09 Dr.Sujnanendra Mishra
Rapid Testing in Labor ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],06/07/09 Dr.Sujnanendra Mishra
Rapid Testing in Labor ,[object Object],[object Object],06/07/09 Dr.Sujnanendra Mishra
The Costs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],06/07/09 Dr.Sujnanendra Mishra
Conclusions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],06/07/09 Dr.Sujnanendra Mishra
06/07/09 Dr.Sujnanendra Mishra Thanks  for  Saving  me  Let The FUTURE say ;
06/07/09 Dr.Sujnanendra Mishra PPTCT  HELPS  PROTECT  THE   FUTURE
06/07/09 Dr.Sujnanendra Mishra THANK YOU

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