"Orphan child (contact with HIV) - how to help find adoptive parents?" Diagnosis of HIV infection in young children HIV contact children

HIV infection. In my opinion, no other disease causes more fear in potential parents. The majority still perceive an HIV-infected person as a direct threat to life, as a death sentence, which is “final and not subject to appeal”. Much of this fear stems from a lack of information about this disease.

In our region, children born to HIV-infected mothers live in ordinary Orphanages and Orphanages, and this is a great achievement, which became possible thanks to the active work of the Murmansk AIDS Center and the support of the Ministry of Health and Social Development and the Education Committee of the Murmansk region. Unfortunately, in our country there are still some regions in which such children are doomed to live within the walls of children's infectious diseases hospitals, children's institutions refuse to accept them, they do not receive proper communication, development, and education.

Among the children in the social system of our region there are several babies with an already confirmed HIV + diagnosis, and significantly more babies to whom the mother's disease has not been transmitted, however, a terrible record remained in their personal files - “HIV contact”, which frightens off so many potential parents. Despite this, I would like to note that the situation with the placement of HIV-contact children and even HIV + children into families has already moved off the ground. Potential parents now, unlike, for example, several years ago, have access to information regarding this disease. More and more often enough literate articles and stories appear in the media, the main purpose of which is to convey to the audience information about the essence of the disease, about the ways of its transmission, about new achievements in the field of HIV treatment.

Let's see, HIV infection and HIV contact, what is the difference? Is it dangerous to accept a child with such a diagnosis in a family? What do parents need to know if they are thinking about adopting an HIV + child?

So, let's begin.
AIDS (Acquired Immunodeficiency Syndrome) is a disease, the consequence of which is a decrease in the body's defenses (immunity), and the cause of its occurrence is a sharp decrease in the number of lymphocyte cells, which play a central role in the body's immune system.

The culprit of this disease is the human immunodeficiency virus, abbreviated as HIV (HIV), which gave the name of the initial stage of the disease as HIV infection. This virus was discovered relatively recently, in the early 80s of the last century, but thanks to the efforts of scientists, it has now been studied quite well.

HIV is unstable in the external environment. The virus dies very quickly when boiled (after 1-3 minutes), it is almost completely inactivated by heating at a temperature of about 60 ° C for 30 minutes. It also quickly dies under the influence of disinfectants usually used in medical practice (3% hydrogen peroxide solution, 70% ethyl alcohol, ether, acetone, etc.).

Infection with HIV is possible in several ways: sexually, parenterally (through the blood) and vertical (from mother to fetus). The source of infection is an HIV-infected person, at any stage of the disease.

At a certain moment, the activation of the virus occurs, and the rapid formation of new viral particles begins in the infected cell, which leads to the destruction of the cell and its death, while new cells are damaged. Unfortunately, HIV is not indifferent to precisely those cells that are involved in the formation of the body's immune response. With such a defeat, a situation arises in which the cells that guard the body not only do not help in the fight against foreign agents, but are themselves recognized by the immune system as foreign and are destroyed. There is a gradual destruction of the human immune system, which becomes defenseless against infectious diseases, including those that normally do not pose major problems for the immune system and are not dangerous at all.
According to the Moscow AIDS Center, today the probability of having an infected child from an HIV-infected woman is on average about 30%, this figure is influenced by many factors, one of the main is the woman's viral load (in other words, the concentration of the virus in her blood). However, provided that a pregnant woman takes preventive measures prescribed by a doctor, the risk of giving birth to an HIV-infected child can be reduced to 1-5%.

This means that out of 100 children born to HIV-infected mothers, up to 99 children will be healthy. Again, this is possible if a woman adheres to the doctor's recommendations during pregnancy. Unfortunately, women whose children end up in orphanages, orphanages, often do not adhere to these recommendations, they may not be registered at all due to pregnancy, and may not receive treatment for HIV infection. In this case, the percentage of HIV transmission from mother to child increases significantly.
How is HIV infection diagnosed in children? When can you understand whether the virus was transmitted from a bio-mother to a child?

Soon after giving birth, it is impossible to give an answer as to whether the baby is infected or not. It takes a certain amount of time. Most often, antibodies to HIV are found in the blood of newborns, transmitted passively by the mother, which subsequently disappear from the child's body as the child grows. This means that the child is not infected.

Children whose HIV-infected mothers passively pass HIV antibodies to them) are considered HIV-positive. They are monitored at the AIDS Center and the children's polyclinic at their place of residence, they pass the necessary tests there to timely track whether the maternal antibodies are leaving the child's blood. This condition, according to the International Classifier of Diseases (ICD-10), is designated as an inconclusive test for HIV.

These children make up the majority of children born to HIV-infected mothers. As the child grows, maternal antibodies are destroyed and, usually after 1.5 years of age, laboratory tests for HIV infection are negative. In this case, children are removed from the dispensary registration. Sometimes maternal antibodies disappear a little later, then the period of observation of the child can be extended.

In accordance with order No. 606 of the Ministry of Health of the Russian Federation dated 19.12.03, for removing a child from the register at the age of 18 months. the following conditions must be met:

• negative test result for antibodies to HIV infection
• lack of clinical manifestations of HIV infection.

If the tests carried out show that the child is still infected, then upon reaching the age of 1.5, he is diagnosed with HIV infection, he continues to be monitored by the specialists of the AIDS Center, and, if necessary, therapy is selected for him. The diagnosis can be confirmed in a child at an earlier age if there are clinical signs of HIV infection and the results of additional specific studies. With the right treatment, with timely medication, the prognosis of HIV + children is favorable.
Thus, if you liked the child in the database, you called or came to an appointment with the guardianship authorities and they tell you that the bio-mother of this child is HIV +, do not rush to conclusions, take a referral to the child, go to the Orphanage, specify there how many times the child has already been tested for HIV infection. Pay attention to the age of the child, the HIV test is usually done for children at 3-6-9 months and then every 3 months. I strongly advise that if you like a child whose profile contains an entry for HIV contact, HIV infection, etc., be sure to sign up for a consultation at our AIDS Center. There you can get answers to all your questions from those who have experience, qualifications and, in addition, observe this particular child from birth specifically for HIV infection.

If as a result you find out that the child you like is HIV +, the diagnosis is confirmed, this is not the end either. You should not go into hysterics, and bury the child alive in your imagination. You need to pull yourself together and think calmly.

1. An HIV + child is NOT INFECTED for others, it does not pose the slightest danger to you, to your blood children, etc. There is no HIV infection in the home. If there was at least one case of infection in this way, there would be no federal laws or orders from the Ministry of Health that there are no restrictions on communicating with such people.
2. An HIV + child can attend kindergarten and school on an equal basis with all other children; you have the right not to disclose the child's diagnosis in these institutions. The law protects the secrecy of the diagnosis, in our city HIV + children attend kindergartens and schools, no one has any problems. In our city, medical care for HIV + children is organized very well, no one will point a finger at you, every clinic has HIV + children registered, you will not be the first and last, these children are no longer wild!
3. There is an AIDS Center in Murmansk that monitors children from all over the Murmansk region. Here your child will be registered, take tests every 3 months, all the specialists of the center are very friendly, always ready to come to your aid and give you advice. The center employs psychologists (t. 473299), an infectious disease specialist (t. 472499), a pediatrician (t. 473661), and a social worker.
4. If, according to clinical and laboratory data, the child needs special treatment, then it will be prescribed in a timely manner and absolutely free of charge (for life!). Most often, children take medication 2 times a day, morning and evening. Preparations for babies are most often in the form of syrups, provided that the therapy is successfully selected, children tolerate it well, side effects are rare. Children are active, lead the most normal lifestyle, can play sports, etc. These are the most ordinary children.
5. Then, when the child reaches adolescence and realizes his diagnosis, a very important moment will come. The child must clearly understand what is the difference between him and his peers. Unfortunately, what he can and cannot do. And what is he forbidden? He cannot be a blood and organ donor, and he must be very responsible in choosing a partner for creating a family. When it comes to choosing a partner, HIV-infected people can create couples. Moreover, the child will be able to give birth to your healthy grandson or granddaughter. Many people do not understand that an HIV-infected woman can give birth to a healthy child. The risk of transmission of the virus with complete prevention can be less than 1%. A family can raise an HIV-infected son or daughter and have healthy grandchildren.
6. For us, northerners, the issue of summer vacations is relevant. Your family is used to traveling to hot countries in the summer, won't it be harmful for the HIV + child? HIV - infected children can go to the sea in summer, swim and relax. The only thing, specially to lie in the open sun, purposefully sunbathe is not recommended for them. Agree, active tanning is not recommended for all northern children. It is advisable to ask the kid to put on a light T-shirt and panama hat.
7. Does an HIV-infected child need a special diet? What can and cannot be eaten? In principle, you can eat anything, but there are small restrictions when taking medications (for example, you cannot use grapefruit juice, infusions of certain medicinal herbs, since they can react with therapy and reduce its effectiveness).

An HIV-positive child can be compared in many ways to a child with diabetes: the child receives medication 2 times a day. Your task, as a parent, is to love your baby, to make sure that the child receives medications on time, sleeps more, walks more, and eats properly and fully. And that's by and large everything.

When receiving therapy, such children will live a long time, create their own families and give birth to children. According to my observations, HIV + children for the most part are very beautiful, as if nature, due to their bright extraordinary appearance, wants to give them an extra chance to find a family.

Think about it, if you like a particular child, perhaps his HIV infection is not at all a reason to shed tears and refuse him. Give him a chance, and the child will thank you three times with his love!

A child born to an HIV-infected woman is monitored at the Center for the Prevention and Control of AIDS with a diagnosis of "Perinatal contact for HIV infection", which corresponds to the ICD-10 code R75. In the future, depending on the detection of HIV infection in a child, he or she is either removed from the register, or transferred to the register with a diagnosis of HIV infection.

Clinical examination of children born to HIV-infected women is extremely important from the first days of life. With timely medical examination, several tasks can be implemented:

1. Maintaining adherence to child use of zidovudine (for the purpose of postnatal prevention of mother-to-child transmission of HIV)
2. Prevention of Pneumocystis pneumonia
3. Counseling to stop breastfeeding
4. Identifying and monitoring side effects
5. Early diagnosis of HIV infection
6. Removing a child from the register

For postpartum prevention of mother-to-child transmission of HIV, starting from the first 8-12 hours of life, the newborn receives zidovudine in syrup at 2 mg / kg every 6 hours (or 4 mg / kg every 12 hours) for 4 weeks. Premature babies with a gestational age of 35 weeks or less are prescribed zidovudine in the same dosage, but with a different frequency: with a gestational age of less than 30 weeks - 2 times a day; with a gestation period of 30-35 weeks - the first two weeks of life 2 times a day, and after that - 3 times a day 1.

Pneumocystis pneumonia prophylaxis is carried out for all children with perinatal contact for HIV infection from 4 weeks of life to 4 months, further the need is established depending on the presence / absence of HIV infection 2.

Commitment, i.e. adherence to the drug regimen is entirely dependent on the mother or the person caring for the child. It is necessary to strictly adhere to the prescribed time for taking the drugs and observe the dosage. The recalculation of a single dose of zidovudine in syrup for a newborn is performed regularly with an increase in body weight by 10% 1.

Breastfeeding issues, in most cases, are discussed with an HIV-infected woman during pregnancy. It is important that the patient independently and consciously makes the decision to stop breastfeeding. If a woman decides to breastfeed, it is necessary to provide harm reduction counseling. explain to her how you can minimize the risk of infection in your child.

To identify the side effects of zidovudine (anemia, toxic effects on the liver), early diagnosis of HIV infection and determine the criteria for deregistration within the prescribed time frame, a clinical and laboratory examination of the child is carried out.

It is necessary to strive for the earliest determination of the child's HIV status for the timely initiation of antiretroviral therapy. PCR helps early diagnosis of HIV in a child:

• HIV infection is diagnosed when there are two positive results taken at least 1 month apart, regardless of the child's age. At this stage, the infectious disease specialist may decide to prescribe combination antiretroviral therapy for the child.
• If there are two negative PCR results in a child who does not receive breast milk, it is most likely that there is no HIV infection in the first months of life.

According to the Order of the Ministry of Health and Social Development No. 375, the determination of antibodies to HIV by ELISA (and an immune blot with a positive ELISA) is carried out at the age of 9, 12, if necessary, 15 and 18 months:

• A positive result is confirmed by the determination of antibodies to HIV by the method of immune blotting at the age of 15 and 18 months
• The absence of HIV infection is evidenced by two or more negative tests for antibodies to HIV (immunoglobulin G - IgG), carried out in a child over 12 months old, with an interval of at least 1 month between studies, as well as the absence of other clinical and / or virological laboratory signs of HIV -infections

Removal from dispensary registration of a child born to an HIV-infected woman, according to the Order of the Ministry of Health No. 606, is carried out if all of the following criteria are met:

• Age 18 months
• Negative test result for antibodies to HIV by ELISA
• Absence of hypoglobulinemia
• Absence of clinical manifestations of HIV infection

It must be remembered that children born to HIV-infected mothers undergo medical examination not only at the Center for the Prevention and Control of AIDS, but also, like everyone else, are observed at the polyclinic at their place of residence. This observation includes:

• Examination by a pediatrician with compulsory anthropometry and assessment of physical and psychomotor development 1 time in 10 days during the neonatal period, and then monthly until deregistration.
• Examination by a neurologist, otorhinolaryngologist and dermatologist - at 1 month, then every 6 months until deregistration.
• Examination by a surgeon, orthopedist and ophthalmologist - at 1 month and at 1 year.

After the child is removed from the register for perinatal contact for HIV infection, he undergoes further medical examination, like all children, only in the polyclinic at the place of residence. There are no peculiarities when observing such a child.

1. Clinical guidelines for the prevention of mother-to-child transmission of HIV infection. FGU RKIB MH and SR RF, FNMTS AIDS, 2009 ()
2. Dispensary observation, care and treatment of children born to HIV-infected women and children with HIV infection: A short guide for specialists in the centers for the prevention and control of AIDS. - M., 2006 .-- 108 p.

Hello dear readers!

I didn’t think long about the next topic for the blog, the ideas were thrown up by life itself.

I do not even know where to start? Probably needed from the very beginning. When Andryushka was almost two years old, I really wanted a second child. This desire was so strong, straight to tears. Everyone tried to dissuade me, they said that it would be very difficult. Indeed, it was hard!

My husband warned me that he was working, so he would not be able to help either. He spoke, but still helped, thank him very much! He doesn't read my articles, but I know that many people understand and see what a special person he is.

We were looking for a boy again, then there was a story with Denis, a boy from Kazakhstan ... So, I was sitting one evening, and Ksenia Igorevna sends me a message: "Anya, help me find a child, a boy!" I ask what it means to "attach", because we are also looking for a boy! The answer was: "The child has HIV contact."

Coming back, I will say that before taking the first baby, we were categorically against four diagnoses: HIV, hepatitis B and C, and we were also not ready to take a child with unsaved intelligence. After Andryusha appeared in our family with contact with hepatitis B and C, and then the diagnosis was not confirmed, of course, we were no longer afraid of hepatitis.

There were two diagnoses that we were "afraid" of. And here I am sitting in the kitchen, my husband is again at work at night, identical with the first situation when I studied the history of hepatitis, and I understand that there is a real child whom we can take, but he may have HIV. You know, at that very moment I was very scared that my husband would say no. This was my only fear.

I sat down and read everything on this diagnosis overnight, because the idea should be “sold” to my husband, having strong counterarguments, otherwise it could be a failure. So I was preparing to propose to my husband to adopt a child, so I did when we took Andryusha, so I can safely recommend this tactic to everyone, it works 100%. I will write a separate detailed article about this, if necessary.

After studying this question, I realized that:

1. It is important to observe safety measures, but the percentage of infection in a domestic environment is so small, honestly, it is simply negligible, there are very few such cases.
2. HIV is sexually transmitted, infection is possible. If the baby is born naturally, the percentage is small.
3. Infection is possible when a baby is breastfeeding - the probability is less than one percent!
4. The child needs therapy: he must be given medicine every day at a strictly defined time, if the diagnosis is confirmed.
5. You need to retake the tests every six months, and after two years - once to confirm or remove the diagnosis.
6. A very small percentage of the fact that HIV contact (this is the reaction of the child's antibodies to the HIV of the blood mother) will be confirmed.
7. Such a child needs to be brought up with the knowledge that he must take care of his sexual partner all his life and use protective equipment during sexual intercourse.
8. Such children can have absolutely healthy children.
9. Children who have a confirmed diagnosis are called "plus signs".
10. Almost all adoptive parents of a plus sign take a second child - also a plus sign, and I understand them.
11. "Plus" is very "beneficial" for orphanages, because these are ordinary children with preserved intelligence, who only need to put a pill in their mouth once a day.

In our environment there are people with this diagnosis, some do not accept therapy at all, some do it only when titers are high (indicators of disease activity in the blood). They have wonderful families and wonderful healthy children! I may not be very precise in terms, I immediately apologize. And someone can correct me, but the essence remains the same.

... I come back to the moment when I sit in the kitchen at night. I asked Ksenia Igorevna what other diagnoses the baby has? It turns out that there are no diagnoses, even on the Apgar scale, the baby had 7 points at birth!

I immediately called my spouse, said that there was a child, and informed about the diagnosis. The husband said: “You are out of your mind! Of course not! Anh, we already have a child, but what if he gets infected? We cannot risk that. " In general, we talked for more than an hour, because I was already savvy, so the "fight against objections" in my performance was carried out at "five plus".

By the way, my husband did not resist for long. I agreed, and we went to see the child. I remember, we go into the ward, they brought him. At this time, the head physician came to the pathology department, carefully began to talk about the diagnosis. My husband calmly turned to her and said: “Yes, we already know everything. And the decision was made. Today we came to get acquainted, as soon as there is an opportunity, we will take the child right away. "

We were also told that Daniel very badly tolerates antiviral therapy, often spits up. I don’t know, maybe they deceived us at the hospital, or maybe he really just vomited milk. We took him home, and two or three times a day he vomited after feeding so that everything that he ate came out. Sorry for such details, but this is also an important experience, maybe it will help you.

Classical homeopathy and our wonderful homeopath helped us, she chose the right drug. By the way, the drug turned out to be the same as that of Andryusha, when we applied for the first time, he was then eight months old. Then the homeopath said that this drug is called "the drug of abandoned children." ...

When we went to donate blood for the second time, Daniel was 8 months old. The result was negative again - a second time. For a long time, the doctor at the Contact Center could not understand how this is so: we do not take the child to hospitals for weighing, we have a medical outlet for vaccinations. We just decided for ourselves that our children would grow up without vaccinations.

Well, actually, the last time we donated blood was three weeks ago. It was very difficult for me psychologically, because the blood is taken from the child without the presence of the mother. And this is correct, probably, because often it is necessary to resuscitate mothers as well ...

Of course, for Daniel, who has been in the hospital twice in two and a half years - at birth and for examination for documents for adoption - donating blood from a vein is a serious test. I cried very hard on my husband's chest while our son was shouting behind closed doors: "Mommy, Mommy ..."

This is the cry of a child for help, to which you cannot react. Of course, Daniel was then taken out to us, of course, we hugged for a long time and roared with him, but I sincerely wish all mothers and children not to be separated even for these three minutes, they seem like an eternity.

The day before yesterday I took the test results, the doctor congratulated that my son was healthy. In the office, I asked in detail if it was possible to breastfeed such babies, and it was she who told me that the probability of getting infected with my mother is less than one percent.

I was very upset, because I so dreamed of establishing breastfeeding, again my husband did not allow me because of the child's diagnosis, and again the diagnosis was not confirmed. Here is a woman's intuition, why I did not insist!

The doctor did not know that it is possible to adopt and establish breastfeeding, who did not know, here is good news! We have at least one such mother with many children in our city, she took a little girl into the family, when there were already two of her children, and arranged feeding, fed her daughter for a very long time. As you can see, nothing is impossible!

I left the doctor's office, took out a certificate again. I sent a photo to my husband, and only then my tear dam burst. I realized how merciful God is, how lucky our Daniel is, what a miracle happened in our family! After all, I was not afraid of the diagnosis, I was not afraid and I am not afraid of difficulties, but I understand how much easier the path is without such a disease.

Indeed, in our country this is a label for life, everyone is fleeing from such people, like the plague. Remembering that day with my husband, I reminded him that we could have abandoned our gray-eyed miracle. The husband said: "I'm even afraid to think, how could we live without him?" And indeed it is. Indeed, over time, the line between friend and foe is erased, and adopted children become larger than their own.

Currently, clinical and laboratory tests have been developed for diagnostics in newborns and children of the first year of life.

1. A child who has had contact with an HIV-infected mother in the perinatal period can be diagnosed with HIV infection only if the results of virological tests for HIV are positive twice. In this case, the results of the study of umbilical cord blood are not taken into account, since the contamination of the test sample with maternal blood is possible. Positive results of double isolation of the HIV strain by virological examination of peripheral blood monocytes or positive results of PCR for DNA or RNA in combination with a single isolation of the HIV strain from monocytes are considered reliable. These two tests are performed at regular intervals, and the baby should not receive breast milk from an HIV-infected mother.

1. A child born to an HIV-infected mother is considered not infected with HIV if the above studies consistently give negative results, and the child must be at least 4 months old and should not receive breast milk from an HIV-infected mother.

1. In a child born to an HIV-infected mother, serologic tests for HIV can remain positive for up to 18 months due to persistent maternal antibodies that are transmitted transplacentally. After reaching the age of 18 months, seropositivity persists only in HIV-infected children; while antibodies to HIV-1 can be detected using enzyme-linked immunosorbent assay (ELISA), immunofluorescence (RIF), immune blotting (IV).
2. If a child, in the absence of agammaglobulinemia, has negative serological reactions after reaching 12 months of age, such a child is considered not infected with HIV.

Thus, a child under 18 months. is considered infected if he has an HIV culture, positive PCR or HIV antigen detected in two or more tests. A child born to an HIV-infected mother is considered uninfected if two or more negative tests for HIV antibodies in ELISA are obtained at the age of 6 to 18 months. Or one negative result over 18 months. and there are no other HIV-positive laboratory tests and no AIDS indicator diseases.

Laboratory tests and their interpretation, according to different authors, are given below in table.

Polymerase chain reaction (PCR) allows detecting genomic (proviral) DNA sequences in a polyacrylamide gel using radioactively labeled enzyme probes. PCR is highly sensitive, it allows you to detect HIV DNA in 6 months. before the appearance of antibodies. However, due to false positive results, PCR standardization and the introduction of a fully automated reaction setup are required [Rakhmanova AG, 1996].

In newborns, to differentiate maternal antibodies from those caused by HIV infection, HIV-specific IgA and IgM are determined in the blood serum, which do not pass through the placenta.

Anti-HIV antibodies of the IgM class can appear in an infected child at 2-3 months of age, but their production with an immature immune system is not natural. In this regard, the absence of antibodies of the IgM class still does not allow making a conclusion about the child's HIV infection. On the contrary, the detection of antibodies of the IgA class is a highly sensitive and specific method for diagnosing perinatal HIV infection in children over three and especially six months of age.

In the first months of life in children, a deficiency of B-cell immunity is revealed, which is manifested by a violation of the production of antibodies to bacteria and a decrease in resistance to bacterial infections against the background of severe hypergammaglobulinemia.

With early transplacental infection, the virus is not recognized by the immature immune system and antibodies to HIV are not produced in children.

Nevertheless, in any case, the final diagnosis of HIV infection in a child who was born to an HIV-positive mother in most cases (due to the lack of modern laboratory diagnostics in many hospitals) is established only when the detection of anti-HIV antibodies continues more than 18 months after birth. Due to the possible delay in the appearance in some of these children of their own anti-HIV antibodies, standard serological tests are repeated every 3-6 months until the age of three years (if possible, using the results of HIV culture).

Analyzing various diagnostic criteria for the diagnosis of HIV infection, P. Palumbo and B. Sandra (1998) note that virological studies are of greater value for HIV infection in newborns and children than serological ones. The results of PCR or detection of the culture of the virus in the peripheral blood are the most reasoned for the diagnosis of HIV infection.

It is possible to detect p24 antigen, but this is less specific. However, each positive diagnostic test requires redetermination, as false positive results are possible.

For example, a decrease in body weight, premature birth, microcephaly, and discrania may indicate transplacental infection in newborns.

Other signs of congenital HIV infection are also distinguished - craniofacial dysmorphism (hypertaylorism, wide protruding forehead, sinking nasal bridge, protruding groove of the upper lip), retardation in psychomotor development, recurrent diarrhea, the presence of blue sclera, progressive neurological symptoms (loss of intelligence , motor disorders, pathological reflexes, paresis). The latter is observed in 10-30% of HIV-infected children, and is usually detected at the age of 6 months.

However, clinical criteria are not always acceptable for children in the first months of life. Of great importance are various risk factors for birth, for example, drug addiction in parents, their bisexuality, hemophilia of their sexual partners [Rakhmanova A. G., 1996].

In addition, in such children, in the presence of neurological symptoms, it is necessary to exclude toxoplasmosis, cytomegalovirus and herpes infections, brain lymphoma, measles and other viral encephalitis, the consequences of birth trauma, and only then associate the pathology of the central nervous system with HIV infection.

The most important tasks when working with children born to HIV-infected mothers are chemoprophylaxis of HIV infection and complete clinical examination, including for the purpose of early diagnosis of HIV infection, prevention of opportunistic infections, selection of the optimal vaccine prophylaxis regimen, and timely administration of antiretroviral therapy. ...

A child born to an HIV-infected woman is subject to registration in accordance with code R75 “Laboratory detection of the human immunodeficiency virus [HIV]. (Non-definitive HIV test in children) "International Statistical Classification of Diseases and Related Health Problems, Tenth Revision. In the event that a child born to an HIV-infected woman has not been tested for HIV by laboratory methods, it is registered in accordance with the code Z20.6 "Contact with a sick person and the possibility of contracting the human immunodeficiency virus". In both cases, the diagnosis "Perinatal contact for HIV infection" is made.

The following groups of children born to women are subject to HIV testing:

with HIV infection;

who were not registered with the antenatal clinic during pregnancy;

not tested for HIV before or during pregnancy;

injecting drugs intravenously before and / or during pregnancy;

having sexual partners who inject drugs intravenously;

who had sexually transmitted diseases during pregnancy;

suffering from viral hepatitis B and / or C.

In addition, children without parental care are subject to HIV testing.

Dispensary observation of a child who has perinatal contact for HIV infection is carried out by a pediatrician of an outpatient clinic network or any other medical and / or social institution in conjunction with a pediatrician of the Center for the Prevention and Control of AIDS. In the course of dispensary observation, the following are carried out: diagnostics of HIV infection, confirmation of the diagnosis or removal from dispensary registration; supervision of the child by a pediatrician and medical specialists; conducting standard and additional laboratory tests; prevention of pneumocystis pneumonia; assessment of physical and psychomotor development.

Clinical examination of children born to HIV-positive women should be carried out by specialists with experience in this field, using all modern methods of diagnosis, treatment and monitoring of HIV infection and HIV / AIDS-related diseases. Outpatient, emergency and counseling assistance to children born to HIV-positive women is carried out by children's polyclinics at the place of residence on a general basis. Specialized care for children is provided by specialized hospitals in the direction of children's polyclinics and / or AIDS Prevention and Control Centers.

Table 3. Schedule of observation of children born to HIV-infected women

Table 4. Schedule of laboratory tests in children born to HIV-positive women

1 study of the immune status is carried out after receiving positive results of the HIV test by PCR. If the latter is unavailable, it can serve as one of the diagnostic criteria (a decrease in the number of CD4 (+) - T-lymphocytes is a characteristic manifestation of HIV infection);

2 is optional;

3 in children receiving chemoprophylaxis of pneumocystis pneumonia with biseptol;

4 the next study: with a negative result - after 1 month and with positive / indeterminate results - after 3 months (if the PCR method was used to diagnose HIV infection).

If a child detects HIV nucleic acids by PCR and / or clinical signs of HIV infection, an in-depth examination is carried out: determination of HIV status, immune parameters, quantitative determination of HIV RNA in blood plasma ("viral load"), identification of HIV-related diseases, and the issue of conducting therapy, including antiretroviral therapy, is also being addressed. Vaccination of an HIV-positive child is carried out at the place of residence in accordance with the recommendations of the pediatrician of the Center for the Prevention and Control of AIDS.

A child with HIV infection routinely visits the Center for the Prevention and Control of AIDS with a frequency of 1 time in 3-6 months, depending on the clinical and laboratory parameters. In the early stages of HIV infection, with normal CD4-lymphocyte counts, clinical examination is carried out at least once every six months; in the later stages and with low CD4-lymphocyte counts - at least once a quarter.

Removal from the dispensary registration of a child born to an HIV-infected woman is carried out on a commission in the absence of clinical and laboratory signs of HIV infection. When deciding on the absence of HIV infection in a child, anamnesis, child development, clinical condition, laboratory tests for HIV infection, child's age, and lack of breastfeeding are assessed.

The final decision on the absence of HIV infection can be made on the basis of negative results of the determination of antibodies to HIV. The minimum observation period for a child in the absence of HIV infection should be at least 12 months from the date of birth or cessation of breastfeeding, provided that adequate diagnostic tests, including virological methods, are performed. If monitoring is carried out by serological methods or by less than two virological methods with a fixed examination period, the child can be removed from the register in the absence of HIV at the age of at least 18 months.

If HIV infection is detected in a child, he remains registered for life. In practice, children whose HIV diagnosis has been withdrawn, but who live in families with HIV-infected parents, will continue to be monitored by contact.