Nutrition and HIV/AIDS: A Training Manual - Linkages Project

• Administration of ZVD and Lamivudine (3TC) to mother and baby during theantenatal, intrapartum, and post-partum periods. 3TC is also a nucleosideanalogue. Epivir is the commercial name.• Administration of Nevirapine (NVP) during labor and to infant within 72 hours ofbirth. This course is preferred because of the low cost ($4 for mother and childpair) and ease of administration (single dose for mother and newborn). NVP is anon-nucleoside reverse transcriptase inhibitor. Viramune is the commercialname.Five perinatal antiretroviral therapy (ART) regimens have been tested for breastfedinfants. Efficacy is reduced over time, likely because trials provided ART only duringthe perinatal period (Farley et al 2000). There are ongoing trials to examine whetherARVs prevent MTCT during breastfeeding. A clinical trial in Uganda (Guay et al 1999)showed that giving a single dose of Nevirapine to mothers during labor and anotherto her infant after delivery reduced transmission in breastfed infants by 42 percentthrough 6 weeks and by 35 percent through 12 months.For additional information on ARVs, refer to Session 6 on nutritional care andsupport for pregnant and lactating women infected with HIV, Session 8 on nutritionalcare for children infected with HIV or born to HIV-infected mothers, and Session 9 onmanagement of drug and food interactions in HIV/AIDS therapy.Optimal obstetric careSafe motherhood and reproductive health programs are advised for PMTCT programs.It is important to support safer labor and delivery practices in the context ofHIV/AIDS. Women should be encouraged to walk during labor, to stay well nourishedand hydrated, and to have a safe delivery plan and a contingency plan for referral.Partographs are recommend to record labor progress and mother-baby vital signs.Artificial rupture of membranes to hasten labor should be avoided, as well as routineepisiotomy for all primagravidas.Following delivery, the baby should be thoroughly dried, and any remaining maternalblood and amniotic fluid should be removed. Vigorous suctioning of the infant’smouth and pharynx right after delivery should be avoided, and cutting and care of205