Due to the nature of the infection, it turned out that the majority of carriers of the virus are young boys and girls who dream of love, family, and children. HIV does not make this impossible, you just need to know how to protect yourself and prevent the infection from passing from mother to baby.
The risk of infecting a child with HIV in pregnant women
If you rely on luck and do not take any preventive measures, almost half of the children will be born with the virus - 40-45%. Subject to all necessary measures, artificial feeding, this figure can be reduced to 6-8%, and according to some reports, to 2%.
More than half of babies become infected during childbirth, approximately 20% each during different periods of pregnancy (especially in the second half) and during breastfeeding.
Planning pregnancy with HIV
The good old truth that connects the health of mother and child is also true here. If a woman knows about her status and wants to get pregnant, she definitely needs to determine the viral load in the blood and find out the number of CD4 cells.
If the test results are not very good (high levels of viruses and insufficient levels of lymphocytes), you will first have to improve them. This will make pregnancy easier, and the risk of HIV transmission will be noticeably lower.
Eg, with CD4 less than 200 the likelihood of the baby becoming infected will be 2 times greater, and the viral load more than 50,000 is considered 4 times more dangerous.
Evaluated approximate diagram taking antiretroviral drugs during future pregnancy:
- if the woman’s condition and laboratory data did not require medications before, it is better to do without them for the first three months after conception;
- If treatment has been started previously, it is not advisable to interrupt it. Firstly, a sharply increasing number of viruses can lead to transmission to the child. In addition, there is a potential for opportunistic infections and drug resistance;
- if the treatment regimen included efavirenz, they try to replace it with other drugs due to the pathological effect on fetal development;
- It is not recommended to prescribe stavudine and didanosine; this regimen is not easily tolerated by pregnant women, and serious liver problems are possible.
Conception during HIV infection
Since with a positive status, sexual intercourse must be protected (with a condom), pregnancy can be problematic.
It's a little easier if both partners live with the virus, but even here there is a risk of exchanging different strains, including drug-resistant ones. In addition, it is believed that this increases the likelihood of transmitting the infection to the child. If there is only HIV in the family one, then we must try not to infect it.
It’s easier to protect an uninfected man– it is enough to collect his sperm in a sterile vessel and carry out self-fertilization using a special kit.
It is more difficult if the virus is detected only in a man. The concentration of HIV in semen is usually very high, so danger to the woman is very likely.
There are several possible solutions:
- reduce the viral load in men to a minimum and select the period of ovulation in women. Unfortunately, this cannot completely protect a woman. And infection during conception is also dangerous for the baby, because in the first few months of infection the number of viruses in the blood is maximum;
- carry out a special manipulation to cleanse the partner’s sperm, separating sperm from seminal fluid (the location of viruses). The resulting material is then injected into the woman.
- . The method is quite complex, expensive and not available to all couples. Isolated individual sperm are combined in a test tube with eggs obtained from a woman, then the embryos are early stages developments are inserted directly into the uterus;
- use of donor sperm from special banks. But some men categorically refuse this opportunity, and for women it can be important to give birth to the child of their loved one.
HIV infection and pregnancy - the basic principles of having a healthy child
Antiretroviral therapy after three months pregnancy. The safest drug is zidovuddin, often used in combination with nevirapine.
Observation by doctors, adequate nutrition, prevention. A premature baby (especially with a term of less than 1 month) is not able to resist the virus and is easily infected.
Treatment and prevention opportunistic diseases in the mother.
Planning the type of birth. Since most babies become infected during childbirth, going to term can reduce this likelihood. But if such an operation is forced to be resorted to due to problems that have arisen, the risk may be even higher.
If it is possible to reduce the concentration of viruses to less than 1000 in 1 μl, normal childbirth also becomes quite safe. You should avoid opening the membranes of the membranes and various obstetric manipulations.
Refusal to breastfeed. Prophylactic appointment antiretroviral drugs for newborns in syrups.
It is impossible to immediately determine whether a child is infected or not. All tests for HIV can be positive for up to one and a half years of life, because maternal antibodies are in his blood and are gradually destroyed. If after this period the result does not change, then it is infected.
More exact method— detection of the virus in the blood using PCR (polymerase chain reaction). At 3, 6 and 12 months, the reliability of this type of diagnosis is 90-99%.
HIV is a human immunodeficiency virus that destroys the immune system.
Women with HIV can have healthy HIV-negative children. Infection occurs through sexual contact.
Signs of HIV during pregnancy
- Heat;
- A sore throat;
- Enlarged lymph nodes;
- Diarrhea.
In 60% of people infected with HIV, there are no symptoms or signs.
Women should get tested for HIV:
- At the stage of pregnancy planning;
- In the third trimester;
- After the birth of the child.
Your partner should also get tested for HIV.
You can get tested at any time, even if you previously refused.
Impact of HIV on a child
A child may become infected with HIV during:
- pregnancy (via the placenta);
- childbirth There is contact with the mother's blood;
- breastfeeding.
To prevent this from happening, the pregnant woman needs to be seen by a doctor. The risk of infection increases if the expectant mother uses drugs and alcohol.
The impact of HIV on pregnancy can be expressed in the form of miscarriages, premature births, and stillbirths.
The doctor determines the possibility of infection of the child. If the risk of infection is high, with the consent of the mother, childbirth is carried out by caesarean section.
Natural childbirth is permitted if low level HIV in the blood.
Children born to an HIV-infected mother must:
- be observed by a pediatrician at the AIDS center;
- undergo prophylaxis for Pneumocystis pneumonia;
- be examined for infections;
- be observed at a local clinic;
- get vaccinated.
Vaccination is carried out in accordance with the vaccination calendar.
Modern doctors have noted a tendency towards an increase in the number of pregnant HIV-infected women. And this, in turn, causes a huge number of difficulties for obstetricians and gynecologists, because there is a high probability of HIV transmission to a child during pregnancy and childbirth. To reduce this risk, HIV-infected pregnant women must follow certain rules while carrying a baby; regular visits to the gynecologist and the use of prescribed medications are mandatory.
Signs and diagnosis of HIV in pregnant women
IN modern world A common question is “is it possible to get pregnant with HIV?” The answer is yes, since quite often a woman who has planned to give birth to a child with her husband does not even suspect that she or her partner has the immunodeficiency virus.
Therefore, in order to detect the disease in a timely manner, the patient must undergo tests to determine the retrovirus during the following periods:
- in the process of planning conception;
- in the third trimester of pregnancy;
- after labor has taken place.
A prerequisite is that the sexual partner be tested. The study is carried out by drawing blood from a vein. False-positive and false-negative results are possible, but only if the person has any chronic diseases, in which case it is necessary to re-donate the biological material.
Modern medicine involves the use of 2 tests for HIV during pregnancy:
- Enzyme immunoassay - indicates the presence of antibodies to the pathogen in a woman’s body.
- Polymerase chain reaction - directly shows the presence of free viruses in the blood.
If a woman is already at the stage of gestation, then testing for immunodeficiency should be carried out at 6-10 weeks. When a pregnant woman is diagnosed with HIV in the early stages, she can make an informed decision - refuse to have a child or start taking medications that reduce the likelihood of transmitting the virus to the baby.
If the test for the presence of immunodeficiency is negative, then you should still undergo a repeat test at 28-30 weeks, since there is a risk of infection for the woman at a later date.
In turn, clear signs of the course of HIV infection in pregnant women are the following:
- a significant increase in body temperature for no obvious reason;
- sore throat, cold symptoms;
- enlarged lymph nodes;
- diarrhea.
Unfortunately, an HIV-infected pregnant woman cannot always notice any health problems in a timely manner and go for a consultation with a doctor, since in 60% of patients the pathogen does not manifest itself in any way.
The main thing to remember is that being diagnosed with HIV during pregnancy is not a stigma. With high-quality and timely treatment, the likelihood of an infant becoming infected can be reduced to 2%.
Managing pregnancy with HIV
If HIV is detected during pregnancy, a long conversation is held with the woman, during which the special importance of taking medicines and visits to an infectious disease specialist. The effectiveness of ARV prophylaxis is monitored, and the presence of various side effects from taking medications is analyzed.
Management of pregnancy in HIV-infected people also includes drawing up a long-term plan for monitoring the patient in a regional consultation and dispensary office. First examination in this institution carried out 14 days before starting the use of ARV drugs. The secondary one is performed within a month after their regular intake. Then the woman must come for tests every 4 weeks.
The pregnancy of HIV-infected people is carefully monitored, so almost every month the level of CD4 lymphocytes and the virus load are determined. In addition, the woman regularly undergoes general and biochemical blood tests.
The number of lymphocytes is detected in order to determine the state of the immune system and select the most suitable drugs for treatment. If during the pregnancy of an HIV-positive woman the number of lymphocytes of this type is reduced, then measures must be taken to prevent the development of Pneumocystis pneumonia and other serious complications.
The level of retrovirus load is determined to determine the effectiveness of ARV therapy and to determine the most optimal option for delivery.
Treatment of HIV in pregnant women
HIV infection and pregnancy is a rather dangerous combination, therefore, after diagnosis, you should not delay medical help, you should immediately begin treatment. Taking medications should not be interrupted, as they can reduce the amount of the pathogen and prevent transmission of the retrovirus to the fetus.
If a pregnant HIV patient knew about her diagnosis even before fertilization, then she should definitely consult a doctor about taking medications. This is due to the fact that previously used drugs can adversely affect the health of the unborn child and the prescribed regimen may need to be reconsidered.
The main thing is that a woman must understand that HIV therapy during pregnancy is carried out to protect the unborn baby, and not the mother, therefore it is impossible to be irresponsible when taking medications. As a rule, treatment is divided into three stages - during pregnancy (up to 28 weeks), from 28 weeks and after labor. It is during these periods that the doctor can make adjustments to the prescribed therapy.
HIV and pregnancy are accompanied by the use of drugs such as Retrovir and Nevirapine. The latter can be taken both in tablet form and intravenously. After childbirth, the woman continues to use these drugs, and the child is prescribed Nevirapine or Azlotimidine syrups. If HIV (AIDS) pregnancy was observed and ARV therapy was not used, then the above drugs are not prescribed to the child.
Pregnancy and HIV: consequences for the fetus
Today the question is quite relevant: how does HIV affect pregnancy? Immunodeficiency can cause regular miscarriages, premature or stillborn babies.
In addition, it is noted Negative influence HIV infection to the fetus even in the case of a live birth. If the baby was infected with intrauterine HIV infection, then the following complications can be expected:
- malnutrition - occurs in approximately 70% of cases;
- serious disorders in the nervous system - the probability of occurrence is from 50 to 70%;
- chronic diarrhea;
- lymphadenopathy - characteristic of 90% of infected children;
- oral thrush;
- developmental delays (mainly of a mental nature) - such manifestations are observed in 60% of cases.
When the central nervous system The baby may experience signs such as atrophy of the cerebellar region and the formation of intracranial calcifications.
It has been established that in pregnant women with HIV, the risk of infecting a child in the absence of any treatment ranges from 30 to 50%; with ARV therapy, this value drops to 2% (only if medication is started on time).
Pregnancy and HIV infection: methods of prevention
It is possible to get pregnant with HIV, but reducing the likelihood of transmitting the pathogen to a child is quite difficult, but it is also possible. Currently, there are no preventive actions that would completely eliminate the risk of infection of the fetus, but a number of measures have been developed aimed at significantly reducing the chances of having a baby with AIDS. These include:
- regular testing for retroviruses;
- a planned caesarean section will protect the baby from infection through the vertical route (during passage through the mother’s birth canal);
- if the decision was made to give birth naturally, then doctors eliminate the possibility of early amniotomy, disinfect the genital canal and reduce the likelihood of ruptures and cuts in the perineal area;
- use of antiretroviral drugs, Zidovudine is prescribed;
- complete exclusion of breastfeeding the baby.
If you follow all the above measures and simultaneously carry out treatment with special drugs, then the probability of giving birth to a healthy child is quite high.
Due attention should be paid to the psychological state of the woman, because a retroviral infection discovered during the examination can lead to nervous breakdowns and fetal loss.
Currently, there are about 40 million people with HIV infection in the world. When the new disease was first discovered, people with HIV were treated as death row. This was due to the late detection of HIV in patients, most of whom were already in the AIDS stage (the final stage of development of HIV infection) and lived no more than a year from the date of diagnosis. Nowadays, a timely diagnosis and proper treatment can delay the development of the disease for a long time. Therefore, women with HIV today can also experience the joy of motherhood - of course, subject to careful medical supervision and treatment.
The causative agent of the disease
HIV belongs to the Retrivi ridae family, subfamily Lentivirus. True to its name (Lentivirus is Latin for “slow” virus), HIV is in no hurry.
Once HIV enters the body, it attacks certain blood cells - T-lymphocytes. These cells play an important role in the immune system: they recognize various foreign agents (bacteria, viruses, cancer cells and toxins) and instruct other cells to destroy them. On the surface of these lymphocytes there are CD-4 molecules, which is why they are also called CD-4 cells. The virus encounters a cell on the surface of which there is a CD-4 molecule, the shell of the virus and the cells merge, and the genetic material of the virus enters the cell, integrates into the nucleus and begins to control it until the cell dies. By the time HIV infection progresses to AIDS, billions of blood cells already contain the genetic material of the virus.
HIV cannot live in air for more than a few minutes. In fact, this is precisely the reason for the absence of cases of household HIV infection. In general, HIV can be transmitted only in three ways: through blood, sexual intercourse, and from mother to child during pregnancy and childbirth.
Symptoms of HIV
When HIV enters the human body, the immune system begins a long-term fight against the disease. For a long time Only special blood tests can determine the presence of HIV, as well as how successfully the body fights the virus.
Only in some cases are symptoms of HIV present immediately after infection. The first signs of HIV are subtle: a few weeks after infection, a person may have a slight increase in temperature, enlarged lymph nodes, a sore throat, and diarrhea. Such symptoms are most often mistaken for signs of a cold or poisoning, especially since they disappear quite quickly.
The presence of HIV in the body can be completely invisible for 10-12 years. The only thing that may bother a person is a slight enlargement of the lymph nodes. When the number of CD-4 cells (the same T-helper cells) sharply decreases, specific diseases associated with immunodeficiency appear. Such diseases are frequent pneumonia, cytomegalovirus infection, and herpes. In patients at this stage, such infections quickly develop into generalized (widespread) forms and lead to death. This stage of the disease is called AIDS.
Diagnostics
The only reliable method for diagnosing HIV infection is laboratory testing. During pregnancy, HIV blood tests are offered to all women three times during pregnancy. Tests cannot be prescribed forcibly without the patient’s consent. But you also need to understand that the sooner the correct diagnosis is made, the greater the patient’s chances of living a long life and giving birth to a healthy child, even if she is a carrier of HIV. A doctor observing a pregnant woman must tell her about this, and he must also explain the benefits of timely diagnosis of HIV in pregnant women.
The most common method for diagnosing HIV infection is an enzyme-linked immunosorbent assay (ELISA), which detects antibodies to HIV in the patient’s blood serum. ELISA can give both false negative and false positive result. A false negative ELISA result is possible with a fresh infection, while antibodies to HIV have not yet been produced by the patient’s body. False-positive results can be obtained when examining patients with chronic diseases and in some other cases. Therefore, when a positive ELISA result is obtained, it must be rechecked using more sensitive methods.
Polymerase chain reaction (PCR) allows you to directly determine the presence of the virus. Using PCR, the amount of free viruses circulating in the blood is determined. This amount is referred to as the “viral load.” Viral load shows how active the virus is in the blood. PCR, like ELISA, can give a false positive result. Therefore, when positive results are obtained, in addition to the listed methods, other diagnostic methods are used.
After the diagnosis of HIV infection is made, further examination of the patient is carried out, during which the nature of the disease and the degree of immune damage are clarified. The degree of immune damage is assessed by the level of CD-4 cells in the blood.
Course of pregnancy
Pregnancy does not accelerate the progression of HIV infection in women at an early stage of the disease. The number of pregnancy complications in such women is not much higher than in women without HIV. Cases of bacterial pneumonia are somewhat more common. There are no significant differences in mortality and the incidence of AIDS in HIV-infected women who have and have not had a pregnancy.
At the same time, if there is a pregnancy at the AIDS stage, pregnancy complications are much more common. These include more frequent and severe bleeding, anemia, premature birth, stillbirth, low fetal weight, chorioamnionitis, postpartum endometritis (inflammation of the inner lining of the uterus). In general, the more severe the disease and the higher its stage, the more likely pregnancy complications are.
Congenital HIV infection
Mother-to-child transmission of HIV is an established fact. In the absence of special antiviral therapy, children become infected in 17-50% of cases. Antiviral treatment significantly reduces the rate of perinatal transmission of the disease (up to 2%). Factors that increase the likelihood of HIV transmission are: late stage of the disease, infection during pregnancy, premature birth, damage to the fetal skin during childbirth.
HIV can be transmitted in three ways: transplacentally, during childbirth, or after birth through breast milk. The placenta normally protects the fetus from bacteria and viruses in the maternal blood. However, if the placenta is inflamed or damaged, its protective function is affected and HIV infection can be transmitted from mother to fetus. Most often, HIV is transmitted during childbirth. During passage through the birth canal, the baby is exposed to the mother's blood and vaginal secretions. Unfortunately, cesarean section is also not a reliable protection of the fetus from HIV infection; its use is justified if large quantity viruses.
The third way of transmitting the virus to a newborn is breastfeeding, which doubles the risk of infection. Therefore, an HIV-infected woman should not breastfeed her baby.
Children born to HIV-positive mothers will also be HIV-positive immediately after birth. However, this does not mean that they are infected, since children are born with their mothers' antibodies. Maternal antibodies disappear from the baby's blood between 12 and 24 months. It is after this time that one can confidently judge whether the child has become infected. PCR diagnostics can help determine a child’s HIV status earlier. Already 4 weeks after birth, the reliability of PCR is 90%, and after 6 months - 99%.
Some diseases of newborns can also indicate the likelihood of an HIV-positive diagnosis in children: pneumonia caused by pneumocystis, systemic candidiasis (fungal infection of many organs and systems), herpes zoster, chronic diarrhea, tuberculosis. Approximately 20% of infected children develop a severe form of immunodeficiency by the age of one year, with the development of concomitant infections and, in many cases, encephalopathy (brain damage). Most of them die before reaching the age of five. In the remaining 80% of children, on the contrary, immunodeficiency develops after a period of time that exceeds the same period in adults.
Treatment during pregnancy
In non-pregnant women, the decision to initiate antiviral therapy is made based on two tests: the level of CD-4 cells and the viral load.
Modern treatment requires combination therapy - the simultaneous use of two, three or more antiviral drugs. One drug for treating HIV infection is currently used only in one case - in pregnant women, to prevent transmission of HIV to the newborn.
If a woman took combination antiviral therapy before pregnancy, then doctors usually recommend that she take a break from treatment for the first three months of pregnancy. This reduces the risk of developing malformations in the unborn child, and in addition, avoids the development of resistance (a condition in which the virus does not treatable).
Prevention
Prevention of congenital HIV infection is carried out in three ways:
1) HIV prevention among women of childbearing age;
2) prevention unwanted pregnancies among women with HIV;
3) prevention of HIV transmission from mother to child.
Currently, thanks to combination antiviral therapy, people with HIV live for many years, some for more than 20 years. Many women with HIV do not want to miss the opportunity to become mothers. Therefore, prevention of mother-to-child transmission of HIV has become a central element of most government HIV programs.
HIV and AIDS
The first information about HIV infection (human immunodeficiency virus) appeared in the mid-80s of the last century, when an unknown disease was discovered in which adults suffered from immunodeficiency, which had previously only occurred as a congenital defect. Unlike immunodeficiency in newborns, in these patients the decrease in immunity was acquired in adulthood. Therefore, in the first years after its discovery, the disease began to be called AIDS - acquired immune deficiency syndrome.
Pregnancy with HIV infection is carefully planned. But there are cases when a woman finds out about the infection while she is already pregnant. She will undergo antiretroviral therapy (ARV), monitoring the level of essential antibodies, and monitoring the condition of the fetus. To avoid health complications, it is necessary to adhere to the instructions of specialists, because the main task is the birth of a healthy child.
Is it possible to conceive with HIV infection?
Despite the risk of infecting the unborn child with HIV infection, many families, where one of the spouses, and sometimes both, are immunodeficient, decide to have a baby. In such a difficult situation, even the method of conception can reduce the risk of infection of the baby. In fact, the germ cells of both parents are sterile, but the virus is found in abundance in biological fluids.In this regard, doctors have provided several methods of conception in which this possibility is minimized:
1. If a woman is sick, she is asked to undergo the procedure of artificial insemination - during ovulation, that is, the maturation and release of an egg ready for fertilization, pre-collected male sperm is introduced into the vagina.
2. For families and couples where a man is infected, several options are considered:
- Semen purification HIV-positive partner and direct insertion into the woman’s vagina when the mature egg has already been released into the abdominal cavity. This method reduces the risk of infection of the woman, and, consequently, the child.
- In Vitro Fertilization, when, using the laparoscopic method, the female gamete is collected, and in men, sperm are separated from the seminal fluid. The germ cells are artificially fertilized and then placed in the uterine cavity.
- Easy way– unprotected sex is used extremely rarely. To do this, the day of ovulation must be accurately determined so that conception occurs for sure. Otherwise, with repeated attempts, the woman’s risk of infection increases.
How is the diagnosis done?
A timely detected infection can help a woman give birth to a normal baby, so it is advisable to take HIV tests at the pregnancy planning stage. For this purpose, venous blood is taken, like expectant mother, and the alleged father.
The main diagnostic procedures in this case:
- ELISA- linked immunosorbent assay. Laboratory blood test to determine specific antigens and antibodies to HIV proteins. If the serum gives a positive result two times in a row, an immunoblot test is performed, which excludes or confirms infection.
- Polymerase chain reaction– for such an examination, blood is taken, and biomaterial of sperm and secretions from the woman’s genital organs are also collected. The purpose of the study is to establish the genotype (HIV-1, HIV-2) and determine the concentration of the virus in the body. The method helps determine the presence of infection within 10-15 days after infection, but usually it is used to confirm enzyme immunoassay screening.
Main symptoms of HIV infection in pregnant women
HIV infection can appear as early as 2 weeks after a woman is infected, but sometimes, when the immune system is strong, signs of the disease appear much later - after several months. Their one-time appearance may not raise any suspicion of a health hazard, so the diagnosis of immunodeficiency becomes unpleasant news.Pregnant women in the acute stage experience the following typical symptoms:
- temperature rise to high values;
- severe myalgia – muscle pain;
- body aches, joint pain;
- intestinal dysfunction in the form of diarrhea;
- skin rashes on the face, torso and limbs;
- enlarged lymph nodes.
After an exacerbation, a latent stage begins, during which practically no obvious manifestations of the disease are detected. If the immunodeficiency condition quickly becomes chronic, a woman may experience various diseases caused by fungal, bacterial and viral infections.
During pregnancy and HIV infection, it is realistic to carry and give birth to a healthy child only if the disease is at the initial and second stages of development. And only if the woman immediately begins treatment and antiretroviral prophylaxis.
How does HIV infection affect pregnancy?
It is known that HIV infection can negatively affect the course of pregnancy.
Pathology can provoke in a woman:
- development of opportunistic infections: tuberculosis, disruption of the urinary organs and other complications associated with immunodeficiency and negatively affecting pregnancy;
- infection with herpes, syphilis, trichomoniasis and other sexually transmitted infections that can lead to stillbirth of a child;
- unsatisfactory development of the fetus, and sometimes intrauterine death of the baby;
- violation of the fetal membrane and detachment of placental tissues;
- spontaneous miscarriages, which are much more common than in uninfected mothers.
At the conception planning stage, there is a high percentage that the embryo can be implanted outside the uterine cavity, which increases the risk for the life of the woman herself and the death of the fetus.
Transmission of the virus and its effect on the fetus
Despite the fact that there are cases of healthy offspring being born from an infected mother, the risk of infection of the child always exists.Transmission of the HIV virus can occur:
- During pregnancy– the fetus can become infected if, against the background of HIV, multiple pathological processes develop in the mother’s body, including bacterial infection of the placenta, amniotic fluid and umbilical cord. As a result of such a lesion, prenatal rupture of amniotic fluid, stillbirth, or miscarriage may occur. Childbirth, however, is difficult and protracted.
- At the time of birth– passing through the birth canal, the baby comes into close contact with the mother’s mucous tissues and any slight damage to the skin allows the virus to enter the newborn’s body. To protect it, a caesarean section is used at 38 weeks of pregnancy; the operation halves the risk of infection, but there is no guarantee in such a situation.
- After labor– the infection can pass from mother to baby through breast milk, the infection is not transmitted to the child by other means.
As a result of infection during and after childbirth, a baby may experience pneumonia, chronic diarrhea, ENT diseases, encephalopathy, anemia, kidney dysfunction, dermatitis, herpes, and delayed mental and physical development.
The course of pregnancy against the background of HIV
During pregnancy, due to the irresponsible attitude of the woman, as well as complications associated with the infection, there is a high percentage of miscarriages, placental abruption, and growth retardation of the child.First trimester
At this time, as throughout the entire period of gestation, the immunological indicators of CD4 white blood cells decrease markedly, and many concomitant infections can occur. Most often, the expectant mother has to undergo treatment with special drugs that prevent transmission of the virus to the baby. But usually treatment begins from 10 to 14 weeks, and before that the woman does not use any medications, as they can have a detrimental effect on the development of the baby.Second trimester
Starting from the 13th week, intensive therapy with the main antiretroviral drugs is prescribed, these are:- Nucleosides and nucleotides – Phosphazide, Abacavir, Tenofovir, Lamivudine.
- Non-nucleoside reverse transcriptase inhibitors - Efavirenz, Nevirapine, Etravirine.
- HIV protease inhibitors – Nelfinavir, Ritonavir, Atazanavir.
Third trimester
Highly active drugs are used to suppress the retrovirus HAART (the most effective Retrovir (Zidovudine) is prescribed at 7 months); they are often used in combination with each other, but can have significant side effects in the form of liver dysfunction, allergies, decreased blood clotting, dyspepsia. Therefore, doctors often adjust therapy or replace some drugs with others that are safer for the fetus.With antiviral therapy throughout pregnancy, compliance proper nutrition and other recommendations from doctors, the risk of infection is reduced to 2%, despite the fact that without treatment, 30 children out of a hundred become infected - during pregnancy, childbirth and the postpartum period.
Management of pregnant women with HIV infection
When pregnancy occurs against the background of HIV infection, a crucial period begins for a woman, when all efforts should be aimed at giving birth to a healthy baby. All this time she will be under the supervision of doctors - AIDS center specialists will conduct a full medical examination and will support the woman throughout her pregnancy, as well as her direct gynecologist-obstetrician and infectious disease specialist.
In this difficult time, a woman needs:
- take antiviral drugs;
- regularly visit an infectious disease specialist to identify dangerous diseases that arise due to weakened immunity;
- if the fetus is in normal condition, medications can be prescribed to prevent spontaneous abortion, which often occurs in the early stages of gestation;
- V mandatory monthly tests are required to study the state of the immune system, as well as a general and extensive blood test.
Prevention
At conception, preventing the child from becoming infected consists of purifying the sperm of an infected father, in vitro fertilization, and conception using the sperm of a healthy donor. In women, antiviral treatment is acceptable to reduce the viral load before planning pregnancy.Throughout pregnancy, before and after childbirth, chemoprophylaxis of HIV infection with drugs is carried out.
If a woman is already carrying a child, the following preventive measures are applied:
- a pregnant woman with the immunodeficiency virus can only have sexual intercourse using a condom;
- when prescribing medical procedures, only disposable or maximally sterilized instruments should be used;
- Perinatal invasive diagnostics are prohibited;
- prevention of diseases and complications associated with HIV infection is carried out;
- If the fetus is infected before the 12th week, termination of pregnancy may be proposed.
After the birth of the baby, the woman must refuse breastfeeding and we must continue the course of antiviral treatment. In some cases, drug prophylaxis against retroviruses is also prescribed for a newborn.
The desire of some couples to have a child cannot be stopped even by such a terrible diagnosis as HIV infection. But a woman needs to understand that she will have to go through a difficult path and make considerable efforts to ensure that the baby is born healthy. This is a big responsibility and an undeniable risk that must be remembered.
Next article.
