Statistics indicate an annual increase in the number of HIV-infected people. The virus, which is very unstable in the external environment, is easily transmitted from person to person during sexual intercourse, as well as during childbirth from mother to child and during breastfeeding. The disease is controllable, but complete cure is impossible. Therefore, pregnancy with HIV infection should be under medical supervision and with appropriate treatment.
About the pathogen
The disease is caused by the human immunodeficiency virus, which is represented by two types - HIV-1 and HIV-2, and many subtypes. It affects cells of the immune system - CD4 T lymphocytes, as well as macrophages, monocytes and neurons.
The pathogen multiplies quickly and within 24 hours infects a large number of cells, causing their death. To compensate for the loss of immunity, B lymphocytes are activated. But this gradually leads to the depletion of protective forces. Therefore, in HIV-infected people, opportunistic flora is activated, and any infection occurs atypically and with complications.
The high variability of the pathogen and the ability to lead to the death of T-lymphocytes makes it possible to evade the immune response. HIV quickly develops resistance to chemotherapy drugs, so at this stage of medical development it is not possible to create a cure against it.
What signs indicate illness?
The course of HIV infection can last from several years to decades. Symptoms of HIV during pregnancy do not differ from those in the general population of infected people. Manifestations depend on the stage of the disease.
At the incubation stage, the disease does not manifest itself. The duration of this period varies - from 5 days to 3 months. Some people experience early HIV symptoms after 2-3 weeks:
- weakness;
- flu-like syndrome;
- enlarged lymph nodes;
- slight causeless increase in temperature;
- rash on the body;
After 1-2 weeks, these symptoms subside. The period of calm can last a long time. For some it takes years. The only signs may be periodic headaches and constantly enlarged, painless lymph nodes. Skin diseases such as psoriasis and eczema may also occur.
Without treatment, after 4-8 years the first manifestations of AIDS begin. In this case, the skin and mucous membranes are affected by bacterial and viral infections. Patients lose weight, the disease is accompanied by candidiasis of the vagina, esophagus, and pneumonia often occurs. Without antiretroviral therapy, after 2 years the final stage of AIDS develops, and the patient dies from an opportunistic infection.
Management of pregnant women
In recent years, the number of pregnant women with HIV infection has been increasing. This disease can be diagnosed long before pregnancy or during the gestational period.
HIV can pass from mother to child during pregnancy, during childbirth, or through breast milk. Therefore, planning pregnancy with HIV should be done together with a doctor. But not in all cases the virus is transmitted to the child. The following factors influence the risk of infection:
- maternal immune status (number of viral copies more than 10,000, CD4 - less than 600 in 1 ml of blood, CD4/CD8 ratio less than 1.5);
- clinical situation: the woman has an STI, bad habits, drug addiction, severe pathologies;
- virus genotype and phenotype;
- condition of the placenta, the presence of inflammation in it;
- gestational age during infection;
- obstetric factors: invasive interventions, duration and complications of childbirth, water-free interval;
- the condition of the newborn’s skin, the maturity of the immune system and digestive tract.
The consequences for the fetus depend on the use of antiretroviral therapy. In developed countries, where women with infection are monitored and follow instructions, the effect on pregnancy is not apparent. In developing countries, the following conditions may develop with HIV:
- spontaneous miscarriages;
- antenatal fetal death;
- accession of STIs;
- premature;
- low birth weight;
- infections of the postpartum period.
Examinations during pregnancy
All women donate blood for HIV upon registration. A repeat study is carried out at 30 weeks, a deviation up or down by 2 weeks is allowed. This approach makes it possible to identify at an early stage pregnant women who are already registered as infected. If a woman becomes infected on the eve of pregnancy, then the examination before childbirth coincides with the end of the seronegative period, when it is impossible to detect the virus.
A positive HIV test during pregnancy provides grounds for referral to an AIDS center for further diagnosis. But a rapid HIV test alone does not establish a diagnosis; this requires an in-depth examination.
Sometimes an HIV test during gestation turns out to be false positive. This situation can frighten the expectant mother. But in some cases, the peculiarities of the functioning of the immune system during gestation lead to changes in the blood that are defined as false positive. Moreover, this may apply not only to HIV, but also to other infections. In such cases, additional tests are also prescribed that allow an accurate diagnosis to be made.
The situation is much worse when a false negative analysis is obtained. This can occur when blood is drawn during the period of seroconversion. This is the period of time when infection has occurred, but antibodies to the virus have not yet appeared in the blood. It lasts from several weeks to 3 months, depending on the initial state of immunity.
A pregnant woman who tests positive for HIV and further testing confirms the infection is offered termination of pregnancy within the time limits established by law. If she decides to keep the child, then further management is carried out simultaneously with specialists from the AIDS Center. The need for antiretroviral (ARV) therapy or prophylaxis is decided, and the timing and method of delivery is determined.
Plan for women with HIV
For those who were registered as already infected, as well as with a detected infection, in order to successfully bear a child, it is necessary to adhere to the following observation plan:
- When registering, in addition to basic routine examinations, an ELISA test for HIV and an immune blotting reaction are required. The viral load and the number of CD lymphocytes are determined. A specialist from the AIDS Center gives advice.
- At 26 weeks, the viral load and CD4 lymphocytes are re-determined, and a general and biochemical blood test is taken.
- At 28 weeks, the pregnant woman is consulted by a specialist from the AIDS Center and selects the necessary AVR therapy.
- At 32 and 36 weeks, the examination is repeated; a specialist from the AIDS Center also advises the patient on the results of the examination. At the last consultation, the timing and method of delivery are determined. If there are no direct indications, then preference is given to urgent delivery through the birth canal.
Throughout pregnancy, procedures and manipulations that lead to disruption of the integrity of the skin and mucous membranes should be avoided. This applies to conducting and. Such manipulations can lead to contact of the mother's blood with the baby's blood and to infection.
When is urgent analysis needed?
In some cases, a rapid HIV test may be prescribed in the maternity hospital. This is necessary when:
- the patient was not examined even once during pregnancy;
- only one test was taken during registration, and there was no repeat test at 30 weeks (for example, a woman is admitted with a threat of premature birth at 28-30 weeks);
- The pregnant woman was tested for HIV at the right time, but her risk of infection is increased.
Features of HIV therapy. How to give birth to a healthy baby?
The risk of transmitting the pathogen vertically during childbirth is up to 50-70%, and during breastfeeding – up to 15%. But these indicators are significantly reduced from the use of chemotherapy drugs and when breastfeeding is stopped. With a correctly selected regimen, a child can get sick only in 1-2% of cases.
Drugs for ARV therapy for prophylactic purposes are prescribed to all pregnant women, regardless of clinical symptoms, viral load and CD4 count.
Preventing transmission of the virus to a child
Pregnancy in HIV-infected people takes place under the guise of special chemotherapy drugs. To prevent a child from becoming infected, the following approaches are used:
- prescribing treatment for women who were infected before pregnancy and are planning to conceive;
- use of chemotherapy for all infected;
- ARV therapy drugs are used during childbirth;
- After childbirth, similar medications are prescribed for the child.
If a woman becomes pregnant from an HIV-infected man, then ARV therapy is prescribed to the sexual partner and to her, regardless of the results of her tests. Treatment is carried out during pregnancy and after birth.
Particular attention is paid to those pregnant women who use drugs and have contact with sexual partners with similar habits.
Treatment upon initial detection of the disease
If HIV is detected during gestation, treatment is prescribed depending on the period when this occurred:
- Less than 13 weeks. ARV drugs are prescribed if there are indications for such treatment before the end of the first trimester. For those who have a high risk of fetal infection (with a viral load of more than 100,000 copies/ml), treatment is prescribed immediately after testing. In other cases, in order to exclude a negative effect on the developing fetus, the start of therapy is delayed until the end of the 1st trimester.
- Duration from 13 to 28 weeks. If the disease is detected in the second trimester or an infected woman applies only in this period, treatment is prescribed urgently immediately after receiving the results of tests for viral load and CD
- After 28 weeks. Therapy is prescribed immediately. A regimen of three antiviral drugs is used. If treatment is first started after 32 weeks and the viral load is high, a fourth drug may be added to the regimen.
A highly active antiviral therapy regimen includes certain groups of drugs that are used in a strict combination of three of them:
- two nucleoside reverse transcriptase inhibitors;
- protease inhibitor;
- or a non-nucleoside reverse transcriptase inhibitor;
- or an integrase inhibitor.
Drugs for the treatment of pregnant women are selected only from groups whose safety for the fetus has been confirmed by clinical studies. If it is impossible to use such a regimen, you can take medications from available groups, if such treatment is justified.
Therapy in patients who have previously received antiviral drugs
If HIV infection was detected long before conception and the expectant mother received appropriate treatment, then HIV therapy is not interrupted even in the first trimester of gestation. Otherwise, this leads to a sharp increase in the viral load, deterioration of test results and the risk of infection of the child during pregnancy.
If the regimen used before gestation is effective, there is no need to change it. The exception is drugs with a proven danger to the fetus. In this case, the drug is replaced on an individual basis. Efavirenz is considered the most dangerous of these for the fetus.
Antiviral treatment is not a contraindication for planning pregnancy. It has been proven that if a woman with HIV consciously approaches conceiving a child and follows the medication regimen, then the chances of giving birth to a healthy baby increase significantly.
Prevention during childbirth
The protocols of the Ministry of Health and WHO recommendations define cases when it is necessary to prescribe Azidotimidine solution (Retrovir) intravenously:
- If antiviral treatment was not used when the viral load before delivery was less than 1000 copies/ml or more than this amount.
- If a rapid HIV test in the maternity hospital gives a positive result.
- If there are epidemiological indications, contact with a sexual partner infected with HIV during the last 12 weeks while using injecting drugs.
Choosing a method of delivery
To reduce the risk of infection of the child during childbirth, the method of delivery is determined on an individual basis. Childbirth can be carried out through the birth canal if the woman in labor received ART during pregnancy and the viral load at the time of birth is less than 1000 copies/ml.
The time of rupture of amniotic fluid must be recorded. Normally, this occurs in the first stage of labor, but sometimes prenatal effusion is possible. Considering the normal duration of labor, this situation will result in an anhydrous interval of more than 4 hours. This is unacceptable for an HIV-infected woman in labor. With such a duration of the water-free period, the likelihood of infection of the child increases significantly. A long period without water is especially dangerous for women who have not received ART. Therefore, a decision may be made to terminate labor by.
During childbirth with a living child, any manipulations that violate the integrity of tissues are prohibited:
- amniotomy;
- episiotomy;
- vacuum extraction;
- application of obstetric forceps.
Labor induction and labor intensification are also not performed. All this significantly increases the child’s chances of infection. It is possible to carry out the listed procedures only for health reasons.
HIV infection is not an absolute indication for cesarean section. But it is strongly recommended to use the operation in the following cases:
Caesarean section completely eliminates the child’s contact with the mother’s genital tract, therefore, in the absence of HIV therapy, it can be considered an independent method of preventing infection. The operation can be performed after 38 weeks. Planned intervention is performed in the absence of labor. But it is possible to perform a caesarean section for emergency reasons.
During vaginal delivery, at the first examination, the vagina is treated with a 0.25% chlorhexidine solution.
After birth, a newborn must be bathed in a bath with aqueous chlorhexidine 0.25% in an amount of 50 ml per 10 liters of water.
How to prevent infection during childbirth?
To prevent infection of the newborn, it is necessary to provide HIV prevention during childbirth. Drugs are prescribed and administered to the woman in labor and then to the born child only with written consent.
Prevention is necessary in the following cases:
- Antibodies to HIV were detected during testing during pregnancy or using a rapid test in the hospital.
- According to epidemic indications, even in the absence of a test or the impossibility of conducting it, in the case of a pregnant woman using injecting drugs or her contact with an HIV-infected person.
The prophylaxis regimen includes two drugs:
- Azitomidin (Retrovir) intravenously is used from the onset of labor until the umbilical cord is cut, and it is also used within an hour after birth.
- Nevirapine - one tablet is taken from the moment labor begins. If labor lasts more than 12 hours, the drug is repeated.
In order not to infect the baby through breast milk, it is not applied to the breast either in the delivery room or subsequently. You should also not use breast milk from a bottle. Such newborns are immediately transferred to adapted formulas. A woman is prescribed Bromocriptine or Cabergoline to suppress lactation.
In the postpartum period, antiviral therapy is continued with the same medications as during gestation.
Preventing newborn infection
A child born to an HIV-infected mother is prescribed medications to prevent infection, regardless of whether the woman has been treated. It is optimal to start prophylaxis 8 hours after birth. Until this period, the drug administered to the mother continues to work.
It is very important to start giving medications in the first 72 hours of life. If a child becomes infected, the virus circulates in the blood for the first three days and does not penetrate the DNA of cells. After 72 hours, the pathogen is already attached to the host cells, so prevention of infection is ineffective.
Liquid forms of drugs for use by mouth have been developed for newborns: Azidotimidine and Nevirapine. The dosage is calculated individually.
Such children are registered at the dispensary until they are 18 months old. The criteria for deregistration are the following:
- no antibodies to HIV when tested by ELISA;
- no hypogammaglobulinemia;
- no symptoms of HIV.
Pregnancy is wonderful moments, it is dreams and dreams, it is real happiness, especially if it is long-awaited. The expectant mother is making plans for how her life will change with the birth of her baby. And in the midst of all this, like a point-blank shot, the diagnosis of HIV can strike. The first feeling is panic. Life is falling apart, everything is going topsy-turvy, but you need to find the strength to stop and think carefully. Pregnancy and HIV are not a death sentence. In addition, you first need to confirm how reliable the diagnosis is.
Better late than even later
Indeed, for many women it is unclear why they need to constantly undergo tests for various infections during pregnancy. After all, they have a happy family, and this definitely cannot happen to them. In fact, pregnancy and HIV very often go hand in hand. It’s just that this disease is very insidious; it can be completely invisible for ten to twelve years. Even if there are a couple of lumps (lymph nodes) on the neck, this may go unnoticed. In some cases, the temperature may rise slightly, sore throat, vomiting and diarrhea may appear.
In order to identify the disease, special laboratory tests are needed. The program for the protection of motherhood and childhood necessarily includes careful consideration of the expectant mother. This is why pregnancy and HIV are two concepts that are often found together. Perhaps, if not for the interesting situation, the woman would never have consulted a doctor.
Diagnostics
As has already been said, the only reliable method of diagnosis is laboratory tests. When a woman registers for pregnancy, she is sent for tests from the first day. It should be noted that they cannot be prescribed forcibly, without the consent of the patient. But this is in your interests, because pregnancy and HIV, occurring simultaneously in the body, should not be left without the supervision of a doctor.
The most popular diagnostic method is ELISA, which detects antibodies to HIV in the patient’s blood serum. PCR allows you to detect the virus cells themselves in the blood. Typically, this examination is carried out when there is already a suspicion of HIV in order to accurately make a diagnosis.
If the doctor tells you such unpleasant news, you should not panic. HIV and pregnancy can coexist quite peacefully, and you may well give birth to a healthy baby. At the same time, we must not forget that it is vital for you to work closely with your doctor, take tests and follow recommendations.
Could there be an error?
Of course it can! This is why you should definitely undergo further examination, especially if you are confident in your partner. The fact is that primary diagnosis is carried out using the already designated ELISA method, which can give both false-positive and false-negative results. HIV and pregnancy at the same time is a blow for any expectant mother, but we must remember that the results obtained are not completely reliable.
A false negative result may occur if the infection occurred very recently. That is, a person is already a carrier, but the body has not yet had time to react and develop protection, antibodies, which doctors find. False-positive tests are even more common, especially in pregnant women. The reasons lie in the physiology of this difficult period. Of course, anyone will not be able to sleep when such news arrives, but first of all you need to weigh how possible such a development of events is, what were the prerequisites for this, and, of course, continue the examination.
Course of pregnancy
HIV and pregnancy can run their course without affecting each other too much. Pregnancy does not accelerate the progression of infection in women who are at an early stage of disease development. According to statistics, the number of pregnancy complications in this case in infected women practically does not exceed that in women without HIV. The only exception is that bacterial pneumonia is diagnosed somewhat more often.
An HIV test during pregnancy is also necessary to assess the stage of development of the disease. By the way, if we compare the mortality rate between those who gave birth and those who refused to do so (we are talking about termination of pregnancy after diagnosis), there are practically no differences.
However, as you already understand, the course of pregnancy very much depends on how long ago the disease has been developing, what stage it was at the time of conception, as well as on the condition of the body. The later the stage, the more complications may arise. These may include frequent and severe bleeding, anemia and premature birth, stillbirth, low fetal weight, and postpartum endometritis. Thus, the more severe the disease, the less chance of carrying and giving birth.
Clinical picture during pregnancy
This point is especially important for those women who learned about their disease already during pregnancy. How does HIV progress during pregnancy, what are the symptoms and treatment of this disease in expectant mothers? These are questions the answers to which could help many women evaluate what is happening to them and take adequate measures. But, unfortunately, it is difficult to describe them more or less accurately. The fact is that the immunodeficiency virus develops and progresses against the background of a weakening of the body’s protective functions. And the more the immune system retreats under its onslaught, the more pronounced the symptoms will be.
Usually, 6-8 weeks after infection, a person begins to experience the first signs, which the expectant mother can easily mistake for a typical pregnancy picture. At this time, you may experience increased fatigue, fever and decreased performance, as well as diarrhea.
What is the main difficulty? This stage does not last long - just two weeks, and the symptoms subside. Now the disease is taking a latent form. The virus enters the persistence stage. The period can be very long, ranging from two to 10 years. Moreover, if we talk about women, then they have a tendency to have a long latent stage; in men it is shorter and does not exceed 5 years.
During this period, all lymph nodes enlarge. This is a suspicious symptom that requires examination. However, here lies the second difficulty: enlarged lymph nodes during pregnancy are normal and very common in healthy people. However, this symptom should definitely alert the expectant mother. It’s better to be on the safe side than to lose precious time.
Intrauterine development of the baby
In this matter, doctors were very interested in one point, namely, at what time the infection occurs. A lot of information for this was provided by tissues from spontaneous miscarriages and infected mothers. Thus, it was found that the virus is capable of causing intrauterine infection already in the first trimester, but the likelihood of this is not too high. In this case, children are born with the most severe lesions. As a rule, they do not live long.
More than half of all cases of infection occur in the third trimester, the period immediately before childbirth and the birth itself.
It is also interesting that until recently, the detection of antibodies to HIV in the blood of a pregnant woman was an indication for immediate termination of pregnancy. This is associated with a high risk of fetal infection. However, today the situation has changed. Thanks to modern treatment, a woman is not sent even for a planned caesarean section if she receives the necessary treatment.
The probability of infection of the baby
As we know, according to statistics, the immunodeficiency virus is transmitted from mother to child. This is one of three ways of infection. HIV positive during pregnancy increases the risk of having a child with a congenital disorder by 17-50%. However, antiviral treatment reduces the likelihood of perinatal transmission to 2%. However, when prescribing therapy, it is necessary to take into account the course of pregnancy. HIV, as we have already described, can also be different. Factors that increase the likelihood of passing it on to the fetus are:
- late treatment when the disease has reached an advanced stage;
- infection during pregnancy;
- complicated pregnancy and difficult childbirth;
- damage to the fetal skin during childbirth.
Infection during childbirth
In fact, if you test positive for HIV during pregnancy, you may well give birth to a healthy baby. But he will be born with his mother's antibodies. This means that immediately after birth the child will also be HIV positive. But for now this only means that his body does not have its own antibodies, but only maternal ones. It will take another 1-2 years until they completely disappear from the baby’s body, and now it will be possible to say for sure whether the child has become infected.
The expectant mother should know that HIV during pregnancy can be transmitted to the baby during intrauterine development. However, the higher the mother’s immunity, the better the placenta works, that is, the organ that protects the fetus from viruses and bacteria in the maternal blood. If the placenta is inflamed or damaged, the likelihood of infection increases. This is another reason why it is necessary to undergo a thorough examination by your doctor.
But most often, infection occurs during childbirth. Therefore, pregnancy with HIV infection must be accompanied by mandatory antiviral therapy to reduce this likelihood to a minimum. The fact is that while passing through the birth canal, the baby has a high chance of coming into contact with blood, which dramatically increases the possibility of infection. If you remember from school, this is the shortest route of transmission of the virus. Caesarean section is recommended if a large number of viruses are detected in the blood.
After childbirth
As we have already said, an HIV test during pregnancy is necessary so that in case of a positive result, the mother can undergo full-fledged therapy and maintain her health. During pregnancy, physiological suppression of the immune system occurs. So while the previous study looked only at pregnancy, others have gone further and found that the development of HIV may accelerate after childbirth. Over the next two years, the disease may progress to a much more severe stage. Therefore, you cannot rely only on the desire to become a mother. Consultation with a doctor is required at the planning stage. Only this approach can become your assistant. HIV positive during pregnancy can seriously undermine health, which subsequently leads to a reduction in quality of life.
Breastfeeding and its dangers
The pregnancy of HIV-infected people can proceed very well when the baby develops normally and is born completely healthy. Of course, his blood will contain the mother’s antibodies, but they may not have an effect on the child’s immunity. However, now the mother faces a choice whether to feed her baby breast milk. The doctor must explain that breastfeeding almost doubles the risk of infection. So giving it up will be the best choice. High-quality formulas will give the baby much better chances for the future.
Your risks
There are a number of factors that may not work in your favor. This is primarily a weakening of the mother's immunity. A high, that is, a large number of viruses in a woman’s blood is also a bad sign. In this case, the doctor may suggest terminating the pregnancy. We have already talked about breastfeeding - 2/3 of all cases of infection of a child from his mother occur during the first six weeks of life. Multiple pregnancy is also a risk factor.
First of all, the expectant mother needs to register as early as possible. Be sure to follow all the recommendations of your doctor, then you will have a better chance of giving birth to a healthy baby. Starting from the 14th week, a pregnant woman can take the antiviral drug Azidothymidine or its analogue. She receives such prevention completely free of charge. If a woman, for a number of reasons, did not take it before the 34th week, then it is necessary to start doing so at a later date. However, the earlier treatment is started, the less chance a mother has of passing the disease on to her baby.
Treatment
HIV therapy during pregnancy requires careful consideration of the mother's condition and the duration of pregnancy. That is why leave it to an experienced doctor and under no circumstances try to self-medicate. If you consulted a specialist before pregnancy, at the time of planning it, then most likely you will be prescribed combination therapy. The decision to start it is made on the basis of two tests - the level of CD-4 cells and the viral load. Current treatment requires the simultaneous use of two or more antiviral drugs.
An HIV test (pregnancy is a reason to cancel combination therapy) is the starting test on which all further treatment is based. Only one antiviral drug is left for the expectant mother to prevent infection of the baby.
If a woman took combination therapy before pregnancy, then if pregnancy occurs, she is recommended to take a break for the first trimester. In this case, blood for HIV during pregnancy is taken, as a rule, three times, and in a particular case the number of samples can be increased at the discretion of the doctor. The rest of the treatment is symptomatic. This allows you to reduce the risk of developmental defects in the unborn baby, as well as avoid the dangerous state of resistance, in which the virus is no longer treatable.
What a woman should remember
Despite the fact that the achievements of modern medicine make it possible to reduce the risk of infection of a child from his own mother to 2%, it still exists. Therefore, you need to weigh the pros and cons, because a woman, even if she is HIV-infected, wants to carry and give birth to a healthy baby. The difficulty is that you will not know for a long time whether your baby was born HIV-positive, and this cannot be predicted in advance. So you have a long and tedious wait ahead of you. The ELISA will give a positive result approximately 6 months after birth, so be patient.
When deciding to give birth, a woman should know what awaits her child if he falls into this unlucky 2%. We remind you that such a minimal probability of giving birth to a baby with the immunodeficiency virus is only possible if the woman did not follow all the doctors’ recommendations, did not undergo constant examinations and did not take medications exactly according to the regimen.
HIV is most severe in those babies who are infected in utero. The symptoms in this case are much more pronounced, and often such children do not live to see one year old. A smaller number manage to experience adolescence, but their life in adulthood can only be predicted hypothetically, since so far there have been no such cases.
Infection with HIV during childbirth or breastfeeding is somewhat easier, because the virus affects an already formed body with a developing immune system. However, the child's life expectancy will be very limited. Usually doctors do not make a prognosis longer than 20 years.
Prevention
Congenital HIV infection means hospitals and medications from childhood. Of course, everything must be done to prevent such developments. Therefore, it is very important to carry out timely prevention of this disease. Today this work is carried out in three directions. First of all, this is HIV prevention among women of childbearing age. The second direction is the prevention of unwanted pregnancies among women with HIV. Finally, the last thing is the prevention of transmission of infection from a woman to her child.
Testing positive for HIV during pregnancy is not the end of the world. However, a woman must be aware that she has a chance to infect her baby. Modern therapy has greatly increased the life expectancy of an HIV-positive person. Many live 20 years or more after infection. However, if for an adult this is a whole life, then for a child it is a chance to meet youth and leave. Medical achievements do not relieve women of responsibility, so first of all, each of them should think about the future of their baby.
Instead of a conclusion
This is a topic that you can talk about endlessly, and there will still be a lot of unsaid. An HIV diagnosis is like a bad dream, ruining all plans for the future, but it is especially tragic to learn about your diagnosis during pregnancy. In this case, the expectant mother faces a difficult choice and enormous responsibility. Give up your baby or give birth? Will he be healthy or will he face endless treatment? All these questions do not have a clear answer. Today we gave you a brief tour and talked about the main problems associated with pregnancy in infected women.
Of course, the achievements of modern medicine have made it possible for a huge number of women to experience this. Today, people diagnosed with HIV believe that they are full members of society, have the right to a family and the birth of healthy children.
Today in our country the topic of HIV infection is acute. Many women may not be aware of their positive status before pregnancy. Some women infected with HIV want to have children, but are afraid of infecting a new person with the virus. The riskiest period when a mother can transmit the virus to her child is the third trimester of pregnancy and the birth process. However, today's medical advances make it possible to conceive and give birth to a healthy baby, even with an infection. HIV and pregnancy are compatible.
HIV and pregnancy: how to give birth to a healthy baby
Women infected with HIV can have children, just like healthy women. If a woman knows about infection, she first needs to contact an AIDS organization, which will diagnose and do everything possible so that the woman can give birth to a healthy person. If a woman does not take any measures, the likelihood of infection of the child is very high.
If a woman with advanced AIDS decides to give birth to a child, the likelihood of infection of the fetus is very high, since there is a high concentration of the virus in the blood, and the woman’s immunity is greatly weakened.
If a woman finds out that she is HIV-infected, first of all she should contact the center, where specialists will first reassure her, tell her more about her condition, conduct research, and talk about precautions. If a woman knows about her HIV status, she must first go to an appointment with a gynecologist, who will determine the timing of pregnancy and its course. Then the pregnant woman should see an infectious disease specialist.
Just two decades ago, the desire of an HIV-infected woman to have a child was considered, if not illegal, then shameful and immoral.
Experts were sure that HIV infection and pregnancy- concepts are completely incompatible. And the possibility of transmission of infection from mother to baby frightened the HIV-infected women themselves. In addition, childbirth could pose a huge danger to the mother. However, in recent years, completely new means have appeared to combat HIV, and today a woman with a similar diagnosis is quite capable of conceiving, bearing and giving birth to an absolutely healthy child.
How to recognize HIV during pregnancy?
The incubation period of this disease can last from two weeks to several months, depending on the state of the immune system. First signs of HIV can be quite vague and most often women at an early stage simply ignore them. Most women learn about the diagnosis only in its acute phase, which is characterized by:
- strong increase in temperature;
- the appearance of muscle pain;
- unpleasant sensations in the joints and throughout the body;
- various types of gastric dysfunction;
- rashes on the skin, body and limbs;
- changes in the size of the lymph nodes.
Very often, a pregnant HIV-positive woman feels weakness, headache, chills, and fatigue. All these symptoms are also characteristic of completely healthy pregnant women. The acute stage gradually flows into the latent stage, when the disease practically does not manifest itself at all. In the absence of proper treatment, a woman’s immunity rapidly declines, and her body becomes especially susceptible to various viruses, fungi and infections.
Important! The chance to carry and give birth to a full-fledged child exists for women whose disease is in the first or second stage of development. In this case, continuous treatment of the disease is a prerequisite.
Diagnosis of the disease
If you promptly determine the presence of HIV infection in an expectant mother, this will give her every chance to successfully conceive, carry and give birth to a healthy child. That is why it is so important to undergo a full examination at the stage of pregnancy planning. HIV infection can be detected using the following methods:
- Polymerase chain reaction- for this it is necessary to draw blood, as well as examine the sperm and biological fluids of both partners. Thus, it is possible to establish the presence and type of HIV infection, if any, as well as its concentration. This method allows you to diagnose the disease within two weeks after the moment of infection.
- Enzyme immunosorbent screening- the most commonly used and effective method for detecting HIV. To do this, partners donate venous blood to check for the presence of specific antibodies to HIV. If such testing gives a positive result twice, then the presence of infection is refuted or confirmed by a special additional test (immunoblot test).
Important! HIV diagnosis is recommended in the first trimester of pregnancy. However, the risk of disease transmission remains throughout pregnancy, so you should be examined at a later stage, as well as after the birth of the child.
Impact of HIV on pregnancy
The presence of HIV infection can negatively affect the course of pregnancy. In some cases, pregnant women with HIV-positive status may develop:
- tuberculosis, pneumonia, various diseases of the genitourinary system;
- chlamydia, herpes, syphilis and other sexually transmitted infections;
- abnormal intrauterine development of the fetus, in rare cases - fetal death;
- placental abruption or disruption of the integrity of the amniotic membrane;
- frequent miscarriages.
Many HIV-infected people experience premature birth, resulting in underweight babies. In addition, during the planning process, there is a high probability of embryo implantation outside the uterine cavity - we are talking about an ectopic pregnancy.
Methods of transmission of HIV infection
Pregnancy in an HIV-infected woman must be carefully planned. However, it also happens that the expectant mother learns about her diagnosis while already pregnant. In this case, she will have to undergo a course of treatment with special drugs aimed at fighting the virus, regularly monitor the level of antibodies in the body, and also monitor the development process and condition of the unborn child.
Of course, the very combination of pregnancy and HIV is extremely dangerous for both the unborn child and the mother, but if a woman is ready to strictly follow all doctors’ instructions and has an understanding of the risks, she has every chance of becoming a happy mother.
Exists three main ways in which HIV can be transmitted from mother to child:
- Through the blood- during the gestation period, the fetus and the expectant mother have a common circulatory system, thus there is a possibility of transmission of infection while in the womb.
- During labor- when the maximum permissible levels of infection are reached, there is a chance of HIV transmission during childbirth through amniotic fluid. In most cases, delivery in HIV-positive pregnant women occurs by cesarean section.
- During breastfeeding- The baby can become infected with HIV from the mother during breastfeeding. The risk of transmission in this case is approximately 25%, since without special precautions, mother's milk contains a fairly high concentration of infection. Most often, HIV-infected mothers in labor prefer artificial feeding.
How to avoid passing HIV to your child?
Many families suffering from the human immunodeficiency virus express a desire to reproduce a child, sometimes even more than one. In this case, even the most seemingly insignificant details must be taken into account, since the possibility of infection of the fetus exists even during the process of conception. Of course, the reproductive cells of the parents cannot be a source of infection, but the infection is present in the fluids of both partners.
There are several ways to conceive relatively safely for such couples. In cases where only a woman is the carrier of the virus, she can undergo artificial insemination, namely, we are talking about artificial insemination. In families where the spouse is infected, you can resort to one of the following fertilization options:
- Sexual intercourse during ovulation- the method is used quite rarely, since the risk of infection of a woman remains quite high.
- ECO- in this case, the fusion of sperm and egg occurs in the laboratory, after which the developing embryo is implanted into the woman’s uterine cavity.
- The partner's seminal fluid undergoes special purification, and is inserted into the partner’s vagina during ovulation. Thus, the threat of transmission of the virus to the woman and unborn child is significantly reduced.
Important! The safest method of conception for HIV-infected women is the method of artificial conception using healthy donor material. However, not all married couples are ready to take this step.
During gestation, childbirth and during feeding, the probability of a child becoming infected is quite high (about 25%) if proper precautions are not taken. Modern techniques can reduce this probability to approximately 2-3%, and this is a very significant shift. What needs to be done for this?
- First of all, do not neglect taking HIV medications. As a rule, a woman with this terrible diagnosis must take medications that contain a certain substance aimed at fighting HIV throughout the entire period of pregnancy and after childbirth. Thus, the chance of transmitting the disease is significantly reduced.
- Childbirth by caesarean section. In this case, it is possible to significantly minimize the child’s contact with the mother’s fluids. Natural childbirth in HIV-infected people is allowed, but only in certain cases.
- Artificial feeding. An HIV-infected woman will most likely have to stop breastfeeding her baby. Today, on the shelves of children's stores there is a fairly wide range of food for newborns, which practically does not differ in properties from natural breast milk.
Is pregnancy dangerous for the woman herself?
According to statistics, pregnancy in most cases is not capable of negatively affecting the condition of an HIV-infected expectant mother. However, some anti-HIV drugs must be avoided during pregnancy because they are extremely harmful to the development of the fetus. In addition, like any healthy woman, a woman with HIV infection should pay special attention to her lifestyle throughout pregnancy, namely:
- completely give up bad habits - smoking and alcohol;
- do not take drugs;
- review your diet, making it as balanced as possible;
- Strictly follow the rules for taking medications aimed at combating HIV.
Important! There are drugs that can cause the development of congenital anomalies in the fetus, which is why their use must first be discussed with your doctor!
In the Department of Reproductology, Alexander Pavlovich Lazarev respects and understands the desire of HIV-positive women to have their own children. And fortunately, even such a terrible diagnosis cannot put an end to the opportunity to give a new life. However, every woman with HIV must realize that she and her husband will have to go through a difficult long journey and make a lot of efforts to ensure that their child is born healthy.
Modern medicine can reduce the likelihood of HIV transmission from mother to child to 2%. From now on, HIV is not a death sentence at all, and in our time this disease does not put an end to the dream of motherhood. You can give yourself and your spouse a completely healthy, strong baby, who will give you a lot of happiness and push negative thoughts about your illness into the background.
HIV infection introduces a large number of restrictions into the lifestyle of those affected and can harm the health of future babies. Are HIV and pregnancy compatible? You should not lose sight of the seriousness of the possible consequences in such a situation, however, there is a chance to become the mother of a full-fledged baby.
How can an HIV-infected woman give birth to a healthy child? This is not an easy task. To achieve the goal, the efforts of the obstetrician, infectious disease specialist and the patient herself must be combined.
Human immunodeficiency virus is a gradually developing disease characterized by a chronic course. The disease causes damage to the immune system, central nervous system and other organ systems with the subsequent development of AIDS. The thermal stage of the disease inevitably leads the patient to death.
Attention! A blood test for HIV is taken by any pregnant woman upon registration at the antenatal clinic.
How can a child become infected?
Can someone with HIV give birth to children? How will this affect the woman and child?
If the patient knows about the ongoing disease, she should not assume that HIV during pregnancy will lead to a deterioration in her well-being. Unpleasant consequences often arise due to the development of secondary ailments and bad habits of a woman. The virus does not have a negative effect on the development of the fetus; the main danger is the possibility of infecting the baby during childbirth.
The infection is transmitted from a sick mother to a child in three ways:
- during gestation (in utero);
- during childbirth, women with HIV infection;
- when breastfeeding.
Children born to HIV-infected mothers who do not take any measures to prevent the baby from becoming infected are born sick in 30% of cases. If appropriate therapy is started during pregnancy, the probability of infection of the child is 2-3%.
Thus, children born to HIV-infected mothers are highly likely to be healthy.
Diagnosis of HIV during pregnancy
Testing for HIV infection during pregnancy is one of the mandatory measures. How many times during pregnancy is such a test used? Ideally, women planning a pregnancy donate blood for HIV 4 times:
- when planning a child;
- upon registration;
- in the third trimester;
- after childbirth.
You can take an HIV test during pregnancy at any time if the woman has not previously donated blood for some reason.
Blood tests for the virus in patients during pregnancy are taken from a vein. In some cases, an HIV test may be false positive. This examination result in the case of pregnant women is observed quite often.
A reaction to an imaginary virus with a false positive result may be explained by the presence of chronic illnesses in the expectant mother. In addition, paternal DNA enters the woman’s body, which acts as a virus for the immune system - the amount of antibodies produced in this case is the reason for a positive reaction.
Virus and pregnancy
Let’s say a married couple is planning a pregnancy if there is HIV infection in the blood of one or both partners. What are the features of such a case? Will pregnancy increase the intensity of the symptoms of the disease? And finally, how to prevent a child from becoming infected?
What are the dangers of pregnancy for a woman?
At what cost will a sick woman have healthy children? How dangerous is pregnancy for an HIV-infected woman?
HIV in pregnant women manifests itself similarly to the symptoms of the disease in healthy women. However, one should take into account the double effect of weakening the immune system of an HIV-infected patient during pregnancy.
Firstly, the expectant mother’s body “slows down” the immune system to prevent embryo rejection, and secondly, the developing disease naturally destroys the protective function of the woman’s body.
Under such circumstances, the risk of developing and acquiring complicated forms of concomitant ailments increases, which the expectant mother cannot avoid.
The pregnant woman’s body is supported by traditional highly active antiretroviral therapy, which is carried out throughout pregnancy (from the third month); a few weeks before giving birth, the pregnant woman is admitted to the hospital.
Can an HIV-infected woman give birth to a completely healthy child: expert opinion
An HIV-infected patient can give birth to a healthy baby. It is possible for infected women to give birth, since the achievements of modern medical science make it possible to reduce the risk of infection of a child born or developing in the womb.
However, it is worth noting that the risk of having a sick baby increases somewhat in pregnant women with a late stage of the disease, as well as those who, due to a weakened immune system, have a fairly high level of viral load.
The risk of infection of the baby also depends on the method of delivery. In the case of a sick woman in labor, it is possible to perform a natural birth (with a viral load of no more than 1000 in 1 μl), however, in order to minimize the risk of infection, abdominal surgery is used.
What care does the mother need during pregnancy?
In most cases, pregnant women do not experience any problems with HIV infection. They need the same prenatal care throughout their pregnancy as healthy mothers-to-be. There is no evidence that women who are ill should receive more frequent counseling than usual (except in cases of complications).
Starting from the second trimester of pregnancy, patients are prescribed specific therapy.
Complications
An HIV-infected pregnant woman may face a number of complications during pregnancy (birth) of a child. So, if the positive result of the HIV test is not false, a woman should prepare for premature birth from the first months of pregnancy.
Another obvious consequence of the development of the virus is AIDS, which burdens pregnancy with various pathologies. A special place in this list of diseases is given to ailments of a viral, fungal, and bacterial nature. These diseases, depending on the general condition of the body, are often complicated in pregnant women.
And finally, the main complication of HIV-infected pregnancy is transmission of the virus to the child in the womb, during the birth of the baby by cesarean section or after surgery (natural birth) while breastfeeding.
Problems conceiving in HIV-positive parents
The possibility of having a healthy child born to infected parents (or one of them), as we found out earlier, is quite high. However, such couples often face various difficulties. The process of conception in HIV-positive parents requires special attention, and care for the newborn is not carried out in the usual way.
Couples in which only one partner is sick must use a barrier protection device - a condom - during sexual intercourse. There are also special methods and recommendations to protect a healthy partner when conceiving a child.
Important!“Special couples” are concerned about the possibility of having a child in traditional conditions. Where do HIV-infected people give birth? Each maternity hospital has special blocks for this class of women in labor - here all the necessary manipulations necessary during the birth process and during the recovery period are carried out.
If both partners are positive
The main danger in the case of HIV-positive status (presence of acquired immunodeficiency syndrome) of both sexual partners is the effect of infection on the fetus, i.e. infection of the child. There is also a risk of transmission of treatment-resistant variants of the virus through contact with a partner.
Before becoming pregnant, a woman and a man should undergo a full examination and consult with specialists to determine the risk of negative viral effects on the fetus.
If the mother is infected
If a woman does not become infected from the future father of the child, there is a clear need to protect the man’s body from infection. To eliminate the risk of infecting a partner when planning a pregnancy with an HIV-positive status, women prefer self-insemination. For this purpose, the seminal fluid is collected in a container, and the expectant mother uses it on days favorable for conception for its intended purpose.
When the first signs of pregnancy appear, the patient should consult a doctor for further registration and management of pregnancy.
Among pregnant women there may be those who are completely healthy and want to have a child from a sick man. What to do in such a situation? What have people come up with to protect mother and baby? Let's move on to the next point.
If the father is infected
Are healthy children born from sick fathers? Let us immediately dispel doubts: a woman can give birth to a healthy baby from an infected father.
In such a situation, the woman’s high risk of infection is obvious. To minimize the likelihood of infecting a partner, firstly, a young man should not neglect the condom during sexual intercourse. Unprotected sex under such conditions is permissible only on days favorable for conception. This measure will not only protect the woman, but will also allow her to conceive, reducing the risk of the child becoming infected if the father is HIV-infected.
The second option is sperm purification using the separation method (separation of dead sperm from living ones). The disadvantage of such a procedure is its high cost, as well as the possibility of application only in the case of a sufficient concentration of healthy sperm in the patient’s seminal fluid.
As mentioned earlier, the baby can become infected when it is born. We will tell you below how to avoid infecting a newborn during childbirth.
Preventing newborn infection
If the expectant mother is HIV-positive, she needs to know and adhere to a number of recommendations:
- follow all medical instructions. Get examined in a timely manner and regularly visit your doctor;
- eat right and lead a healthy lifestyle. This approach is part of the prevention of complications during HIV infection, as well as a guarantee of normal fetal development;
- follow preventive measures to prevent premature birth. A premature baby has an increased risk of infection;
- treat chronic diseases and acute diseases;
- Plan a caesarean section at 38 weeks. The decision to perform an operation is made by a clinic specialist;
- stop breastfeeding. The milk of a sick mother contains a virus. As an alternative, an adapted milk formula is used.
- adhere to prescribed antiretroviral therapy.
How to protect your baby from the virus after birth
In order to prevent infection, a child born to a sick woman is prescribed special medications, regardless of the specific treatment of the woman during pregnancy.
Therapy begins 8 hours after the end of labor. Until this moment, the effect of the drug that the mother took continues. The time interval between the birth of the baby and the first dose of the drug is of great importance. No more than 72 hours should pass from the end of labor. Otherwise, the pathogen will attach to the patient's cells.
For small children, a liquid form of the medicine is provided. They are administered through the oral cavity. The following drugs are used: Azidotimidine and Nevirapine (in a dosage calculated by a specialist).
Over the next 18 months, such children are registered. The reason for deregistration of a child may be: the absence of antibodies to the virus, hypogammaglobulinemia and symptoms of the disease.
Each infected woman has the right to decide for herself how much she needs the baby, even if the child is at high risk of contracting the virus. The main thing is that the decision made is balanced and thoughtful.
Loading...
