Nutrition and diets 

A pregnant HIV infected woman. How to give birth from HIV infected

HIV infection introduces a large number of restrictions into the lifestyle of those who are ill, and can harm the health of future babies. HIV and pregnancy - are they compatible? Do 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 to give birth to a healthy child to an HIV-infected woman? This is not an easy task. To achieve the goal, it is necessary to combine the efforts of the obstetrician, infectious disease specialist and the patient herself.

The human immunodeficiency virus is a gradually developing disease characterized by a chronic form of the 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 given by any pregnant woman when registering at a antenatal clinic.

How can a child be infected?

Can an HIV patient have children? How will this affect the woman and the 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 adversely affect the development of the fetus, the main danger is the possibility of infection of the baby during childbirth.

The infection is transmitted from a sick mother to a child in three ways:

  • during the period of gestation (intrauterine);
  • during childbirth of a woman with HIV infection;
  • when breastfeeding.

Children born from HIV-infected mothers who do not take any measures to prevent infection of the baby are born sick in 30% of cases. If you start appropriate therapy during pregnancy, the chance of infection of the child is 2-3%.

Thus, children born to HIV-infected mothers are likely to be healthy.

Diagnosis of HIV during pregnancy

An analysis for HIV infection during pregnancy belongs to the group of mandatory measures. How many times during pregnancy is this test used? Ideally, women planning a pregnancy donate blood for HIV 4 times:

  • when planning a child;
  • when registering;
  • in the third trimester;
  • after childbirth.

You can take an HIV test during pregnancy at any time if a woman for some reason has not previously donated blood.

Blood tests for the virus in patients during pregnancy are taken from a vein. In some cases, an HIV test may be false positive. Such a result of the examination in the case of pregnant women is observed quite often.

The reaction to an imaginary virus with a false positive result can be explained by the presence of chronic ailments 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 in the presence of HIV infection in the blood of one or both partners. What are the characteristics of such a case? Will pregnancy increase the intensity of the symptoms of the disease? And finally, how to prevent infection of the child?

What is the danger of pregnancy for a woman?

At what price 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, the double effect of weakening the immune system of an HIV-infected patient during childbearing should be taken into account.

Firstly, the body of the expectant mother "slows down" immunity to prevent rejection of the embryo, 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 body of a pregnant woman is supported by traditional highly active antiretroviral therapy, which is carried out throughout pregnancy (from the third month), a few weeks before the birth, the pregnant woman is admitted to the hospital.

Can an HIV-infected woman give birth to an absolutely healthy child: expert opinion

An HIV-infected patient can have a healthy baby. It is possible for infected women to give birth, because the achievements of modern medical science can reduce the risk of infection of a child born or developing in the womb.

However, it should be noted that the risk of having a sick baby increases slightly in pregnant women with a late stage of the disease, as well as those who have a high viral load against the background of a weakened immune system.

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 natural childbirth (with a viral load of not more than 1000 in 1 μl), however, in order to minimize the risk of infection, abdominal surgery is used.

What care does a mother need during pregnancy?

In most cases, HIV infection in pregnant women does not cause any problems. They need the same prenatal care throughout their pregnancy as healthy expectant mothers. There is no evidence that counseling of ill women should occur more frequently than usual (except in cases with 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 in the process of bearing (birth) a child. So, if a positive HIV test result turned out to be 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 all sorts of pathologies. A special place in this list of diseases is given to diseases of a viral, fungal, bacterial nature. These diseases, depending on the general condition of the body, in pregnant women often have a complicated course.

And finally, the main complication of HIV-infected pregnancy is the transmission of the virus to the child in the womb, during the birth of a baby by caesarean section or after surgery (natural childbirth) while breastfeeding.

Problems of conception in HIV-positive parents

The possibility of having a healthy child in 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 newborn care is not carried out in the usual way.

Couples in which only one partner is sick during intercourse must use a barrier means of protection - a condom. To protect a healthy partner when conceiving a child, there are also special methods and recommendations.

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 provides special blocks for this class of women in labor - here all the necessary manipulations are carried out, which are necessary during childbirth and during the recovery period.

If both partners are positive

The main danger in the case of HIV-positive status (the 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 through contact with a partner of therapy-resistant varieties of the virus.

Before becoming pregnant, a woman and a man should undergo a complete examination, consult with specialists to determine the risk of negative viral exposure to the fetus.

If the mother is infected

If a woman was not infected from the future father of the child, there is a fact of the need to protect the body of a man from infection. To eliminate the risk of partner infection during pregnancy planning with HIV-positive status, women prefer self-insemination. For this purpose, the seminal fluid is collected in a container, the expectant mother uses it on days favorable for conception as intended.

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. How to be in such a situation? What did 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? We will immediately dispel doubts: a woman can have a healthy baby from an infected father.

In such a situation, a high risk of infection of a woman is obvious. To minimize the likelihood of partner infection, firstly, a young man should not neglect a condom during sexual intercourse. Unprotected sex under such conditions is permissible only on fertile days. This measure will not only protect the woman, but also allow her to conceive, reducing the risk of infection of the child with HIV infection of the father.

The second option is the purification of sperm by the separation method (separation of dead spermatozoa from living ones). The disadvantage of such a procedure is its high cost, as well as the possibility of using it only if there is a sufficient concentration of healthy spermatozoa in the patient's seminal fluid.

As mentioned earlier, a child can become infected when he is born into the world. How not to infect a newborn during childbirth, we will describe below.

Prevention of infection in the newborn

With HIV-positive status, the expectant mother needs to know and follow a number of recommendations:

  • follow all medical instructions. Timely examination, regular visits to the attending physician;
  • eat right and lead a healthy lifestyle. Such an approach is part of the prevention of complications in HIV infection, as well as a guarantee of ensuring the normal development of the fetus;
  • observe preventive measures to prevent premature birth. Premature babies have an increased risk of infection;
  • treat chronic diseases and acute diseases;
  • plan a caesarean section at 38 weeks. The decision to perform the operation is made by the clinic specialist;
  • stop breastfeeding. The milk of a sick mother contains a virus. An adapted milk formula is used as an alternative.
  • adhere to prescribed antiretroviral therapy.

How to protect a child from the virus after birth

A child born to a sick woman is prescribed special drugs to prevent infection, regardless of the specifics of the woman's treatment during pregnancy.

Therapy begins 8 hours after the end of labor. Until this moment, the effect of the remedy that the mother took continues. Of great importance is the time interval between the birth of the baby and the first dose of the drug. No more than 72 hours should have passed since the end of childbirth. Otherwise, the pathogen will attach to the patient's cells.

For young children, a liquid form of the drug is provided. They are introduced through the mouth. The following drugs are used: Azidothymidine and Nevirapine (at 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 a baby, even if the child has a high risk of contracting the virus. The main thing is that the decision made should be balanced and thoughtful.

Pregnancy with HIV infection is carefully planned. But there are times when a woman finds out about the infection already being pregnant. She will have antiretroviral therapy (ARV), monitoring the level of major antibodies, monitoring the condition of the fetus. In order to avoid health complications, it is necessary to follow 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 contracting an unborn child with HIV infection, in many families where one of the spouses, and sometimes both are immunocompromised, a decision is made to give birth to 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 provide several methods of conception, in which this possibility is minimized:

1. If a woman is sick, she is invited to undergo an artificial insemination procedure - 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:

  • Purification of seminal fluid An HIV-positive partner and direct insertion into the woman's vagina when a mature egg has already entered the abdominal cavity. This method reduces the risk of infection of a woman, and, consequently, a child.
  • in vitro fertilization when, using the laparoscopic method, a female gamete is taken, and in men, spermatozoa are separated from the seminal fluid. Sex cells are fertilized artificially and then placed in the uterine cavity.
  • The easy way- Unprotected sex is extremely rare. To do this, the day of ovulation must be accurately determined so that conception occurs for sure. Otherwise, with repeated attempts, the risk of infection of the woman increases.
3. There is also the safest option.- artificial conception of a woman through the seed of a healthy man, excluding any risks associated with the body of the mother and baby, but not all couples are ready for such a step, based on its moral and legal aspect.

How is the diagnosis carried out?


A timely detected infection can help a woman give birth to a normal baby, so it is advisable to take HIV tests even at the stage of pregnancy planning. For this, venous blood is taken from both the 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. In the event that the serum gives a positive result twice in a row, an immunoblot test is performed, which excludes or confirms the infection.
  • polymerase chain reaction- for such an examination, blood is taken, as well as a biomaterial of sperm and secretions from the female genital organs is taken. The purpose of the study is to establish the genotype (HIV-1, HIV-2), to determine the concentration of the virus in the body. The method helps to determine the presence of infection as early as 10-15 days after infection, but is usually used to confirm enzyme immunoassay screening.
During pregnancy, it is desirable for a woman to undergo an early diagnosis - within the first two months. Since there is a risk of later infection, it is recommended to conduct HIV tests at 30 and 36 weeks of gestation, as well as after childbirth.

The 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 immunity is strong, signs of the disease appear much later - after a few months. Their single appearance may not raise any suspicion of a health hazard, so the diagnosis of immunodeficiency becomes unpleasant news.

In pregnant women in the acute stage, the following typical symptoms are observed:

  • temperature rise to high values;
  • severe myalgia - muscle pain;
  • body aches, joint pain;
  • bowel disorder in the form of diarrhea;
  • skin rashes on the face, trunk and limbs;
  • swollen lymph nodes.
A pregnant woman may have such general signs as weakness, fatigue, a state of chills and fever, and headache. They are easily confused with feeling unwell during a common cold.

After an exacerbation, a latent stage occurs, during which, practically, no obvious manifestations of the disease are detected. If the immunodeficiency state quickly becomes chronic, a woman may develop various diseases provoked by a fungal, bacterial and viral infection.

During pregnancy and HIV infection, it is realistic to endure 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 adversely affect the course of pregnancy.

Pathology can provoke a woman:

  • the development of opportunistic infections: tuberculosis, disruption of the urinary organs and other complications associated with immunodeficiency and adversely affecting pregnancy;
  • defeat by herpes, syphilis, trichomoniasis and other sexual infections that can lead to stillbirth of a child;
  • unsatisfactory formation 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.
Due to the influence of a dangerous infection, HIV patients are more likely to have premature births, and children are born with a lower weight. If pregnancy is accompanied by characteristic symptoms of the disease, the risk of a negative impact on the course of pregnancy also increases.

At the planning stage of conception, 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 the birth of healthy offspring 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 multiple pathological processes develop in the mother's body against the background of HIV, including bacterial infection of the placenta, amniotic fluid and umbilical cord. As a result of such a lesion, prenatal rupture of amniotic fluid, the birth of a dead child, and miscarriage can occur. Childbirth, at the same time, is distinguished by a difficult, protracted character.
  • At the time of birth- passing through the birth canal, the baby is in close contact with the mucous tissues of the mother and any slight damage to the skin allows the virus to enter the body of the newborn. To protect it, a caesarean section is used at the 38th week of pregnancy, the operation reduces the risk of infection by half, but there is no guarantee in such a situation.
  • After childbirth- the infection can pass from mother to baby through breast milk, the infection is not transmitted to the child in other ways.



As a result of infection during and after childbirth, the baby may experience pneumonia, chronic diarrhea, ENT diseases, encephalopathy, anemia, impaired kidney function, dermatitis, herpes, mental and physical developmental delay.

The course of pregnancy against the background of HIV

During pregnancy, due to the irresponsible attitude of the woman, as well as due to the complications associated with the infection, there is a high percentage of miscarriages, placental abruption, and stunted growth of the child.

First trimester

At this time, as throughout the gestation period, the immunological parameters of CD4 white blood cells are markedly reduced, and many concomitant infections can occur. Most often, the expectant mother has to undergo treatment with special drugs that prevent the 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 adversely affect the development of the baby.

Second trimester

Starting from the 13th week, intensive therapy with the main antiretroviral agents is prescribed, these are:
  • Nucleosides and nucleotides - Phosphazid, Abacavir, Tenofovir, Lamivudine.
  • Non-nucleoside reverse transcriptase inhibitors - Efavirenz, Nevirapine, Etravirine.
  • HIV protease inhibitors - Nelfinavir, Ritonavir, Atazanavir.
In addition to drugs in the early and later stages of pregnancy, women are advised to take vitamin complexes, folic acid, and iron supplements.

third trimester

Highly active drugs are used to suppress the HAART retrovirus (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, reduced 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, adherence to proper nutrition and other recommendations of doctors, the risk of infection is reduced to 2%, despite the fact that 30 out of a hundred children become infected without treatment - during pregnancy, childbirth and the postpartum period.

Management of pregnant women with HIV infection

When pregnancy occurs against the background of HIV infection, a responsible period begins for a woman, when all efforts should be directed to the birth of a healthy baby. All this time she will be under the supervision of doctors - the specialists of the AIDS center will conduct a complete medical examination, and will support the woman throughout the pregnancy, as well as her direct gynecologist-obstetrician and specialist in infectious diseases.



In this difficult time, a woman needs:
  • take antiviral drugs;
  • regularly visit an infectious disease specialist to identify dangerous diseases that occur due to a weakened immune system;
  • if the fetus is in a normal state, agents can be prescribed to prevent spontaneous abortion, which often occurs at an early stage of gestation;
  • it is mandatory to take monthly tests to study the state of the immune system, as well as a general and advanced blood test.
Continuous monitoring is necessary for the effective use of ARVs and ART drugs, in addition, this determines the most favorable time and option for childbirth.

Prevention

At conception, the prevention of infection of the child consists in the purification of the sperm of the infected father, in vitro fertilization, conception with the help of the sperm of a healthy donor. In women, antiviral treatment is acceptable to reduce the viral load before pregnancy is planned.

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 an immunodeficiency virus can have sexual intercourse only using a condom;
  • when prescribing medical procedures, only disposable or maximally sterilized instruments should be used;
  • perinatal invasive diagnostics is prohibited;
  • prevention of diseases and complications associated with HIV infection;
  • if the fetus is infected before 12 weeks, termination of pregnancy may be offered.
In relation to childbirth, optimal delivery is planned in advance. Basically, surgical removal of the newborn is used.

After the birth of the baby, the woman must stop breastfeeding and continue the course of antiviral treatment. In some cases, drug prophylaxis against a retrovirus 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 so that the baby is born healthy. This is a big responsibility and an undoubted risk that must be remembered.

Next article.

Just two decades ago, the desire of an HIV-positive woman to have a child was considered, if not illegal, but shameful and immoral.

The experts were convinced that HIV infection and pregnancy- the 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 be of great danger to the mother. However, in recent years, completely new means have appeared to fight HIV, and today a woman with such a diagnosis is quite capable of conceiving, enduring and giving birth to an absolutely full-fledged 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 immunity. The first signs of HIV can be quite vague and most often women simply ignore them at an early stage. Most women learn about the diagnosis only in its acute phase, which is characterized by:

  • a strong rise in temperature;
  • the appearance of pain in the muscles;
  • discomfort in the joints and throughout the body;
  • various types of disorders of the stomach;
  • 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, fatigue. All these symptoms are also inherent in absolutely healthy pregnant women. The acute stage gradually flows into the latent one, when the disease practically does not manifest itself. In the absence of proper treatment, a woman's immunity is rapidly falling, and her body becomes especially susceptible to various viruses, fungi and infections.

Important! The chance to endure and give birth to a full-fledged child exists in women whose disease is in the first or second stage of development. In this case, a prerequisite is the continuous treatment of the disease.

Diagnosis of the disease

If a future mother is diagnosed with HIV in a timely manner, this will give her every chance to successfully conceive, bear and give birth to a healthy child. That is why it is so important to undergo a complete examination at the stage of pregnancy planning. HIV infection can be detected by the following methods:

    1. polymerase chain reaction- for this it is necessary to take a blood sample, as well as examine the semen and body 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 as early as two weeks after the moment of infection.
    2. ELISA screening- the most commonly used and effective method for determining HIV. To do this, partners donate venous blood 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 testing is recommended during the first trimester of pregnancy. However, the risk of transmission of the disease remains throughout pregnancy, so it should be examined at a later date, as well as after the birth of the child.

Impact of HIV on pregnancy

The presence of HIV infection can adversely affect the course of pregnancy. In some cases, HIV-positive pregnant women may develop:

  • tuberculosis, pneumonia, various diseases of the genitourinary system;
  • chlamydia, herpes, syphilis and other sexual infections;
  • abnormal intrauterine development of the fetus, in rare cases - fetal death;
  • placental abruption or violation of the integrity of the amniotic membrane;
  • frequent miscarriages.

Many HIV-infected people have preterm births, resulting in underweight babies. In addition, during the planning process, there is a high probability of implantation of the embryo outside the uterine cavity - we are talking about an ectopic pregnancy.

Ways of transmission of HIV infection

Pregnancy in an HIV-infected woman must be carefully planned. However, it also happens that the expectant mother finds out about her diagnosis while already in position. In this case, she will have to undergo a course of treatment with special drugs aimed at combating the virus, regularly monitor the level of antibodies in the body, and also monitor the development process and the 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 comply with all the doctors' prescriptions and has an idea of ​​the risks, she has every chance of becoming a happy mother.

Exists three main ways that HIV can be transmitted from mother to child:

      1. Through the blood- during the period of gestation, the fetus and the expectant mother have a common circulatory system, so there is a possibility of transmission of infection during their stay in the womb.
      2. During childbirth- when the maximum allowable infection values ​​are reached, there is a chance of HIV transmission during childbirth through the amniotic fluid. In most cases, delivery in HIV-positive pregnant women occurs by caesarean section.
      3. During the period of breastfeeding- The baby can get HIV from the mother while breastfeeding. The risk of transmission in this case is about 25%, because without special precautions, breast milk contains a fairly high concentration of infection. Most often, HIV-infected women in labor prefer artificial feeding.

How to avoid passing HIV to a 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 conception process. Of course, the germ cells of the parents cannot be the 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, artificial insemination can be performed on her, namely, we are talking about artificial insemination. In families where the spouse is infected, one of the following fertilization options can be resorted to:

      1. Sexual intercourse during ovulation- the method is used quite rarely, since the risk of infection of a woman remains quite high.
      2. ECO- in this case, the fusion of the sperm and the egg occurs in the laboratory, after which the developing embryo is placed in the woman's uterine cavity.
      3. The seminal fluid of the partner is subjected to special purification, and is inserted into the partner's vagina during ovulation. Thus, the threat of transmission of the virus to a woman and an unborn child is significantly reduced.

Important! The safest method of conception for HIV-infected women is artificial conception with healthy donor material. However, far from all couples are ready to take this step.

In the process of gestation, childbirth and during the period of feeding, the probability of infection of the child is quite high (about 25%) if proper precautions are not taken. Modern techniques are able to reduce this probability to about 2-3%, and this is a very significant shift. What needs to be done for this?

      1. First of all, do not neglect taking HIV medications. As a rule, a woman with this terrible diagnosis must, throughout the entire period of pregnancy and after childbirth, take funds that contain a certain substance aimed at combating HIV. Thus, the chance of transmission of the disease is significantly reduced.
      2. Childbirth by caesarean section. In this case, it is possible to significantly minimize the contact of the child with the mother's fluids. Natural childbirth in HIV-infected people is allowed, but only in certain cases.
      3. Artificial feeding. An HIV-infected woman will most likely have to stop breastfeeding her baby. To date, on the shelves of children's stores there is a fairly wide range of nutrition 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 able to negatively affect 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 abandon bad habits - smoking and alcohol;
  • do not take drugs;
  • review your diet, making it as balanced as possible;
  • strictly follow the rules for receiving funds aimed at combating HIV.

Important! There are drugs that can cause the development of congenital anomalies in the fetus, which is why their intake must first be discussed with your doctor!

In the Department of Reproductology, Lazarev Alexander Pavlovich respects and understands the desire of HIV-positive women to have their own children. And fortunately, even such a terrible diagnosis is not able to put an end to the opportunity to give a new life. However, every woman with HIV must be aware that she and her husband will have to go through a difficult long journey and make a lot of efforts so that their child is born healthy.

Modern medicine is able to reduce the probability of transmission of HIV infection from mother to child to 2%. From now on, HIV is not a sentence at all, and in our time this disease does not put an end to the dream of motherhood at all. 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.

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 like suicide bombers. This was due to the late detection of HIV in patients, most of whom were already at the stage of AIDS (the end stage of the development of HIV infection) and lived no more than a year from the moment of diagnosis. Now, a timely diagnosis and competent 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 Retriviridae family, subfamily Lentivirus. Justifying its name (Lentivirus in Latin "slow" virus), HIV is in no hurry.

Once in the body, HIV 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 order other cells to destroy them. On the surface of these lymphocytes are CD-4 molecules, therefore they are also called CD-4 cells. The virus encounters a cell with a CD-4 molecule on its surface, 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 develops into AIDS, billions of blood cells already contain the genetic material of the virus.

HIV cannot live in the air for more than a few minutes. Actually, this is precisely the reason for the absence of cases of domestic HIV infection. In general, HIV can be transmitted only in three ways: through the blood, sexually, from mother to child during pregnancy and childbirth.

HIV symptoms

When HIV enters the human body, the immune system fights the disease for many years. 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, immediately after infection, symptoms of HIV are present. The first signs of HIV are implicit: a few weeks after infection, a person may have a slight fever, swollen lymph nodes, sore throat, and diarrhea. Such symptoms are most often mistaken for signs of a cold or poisoning, especially since they disappear fairly quickly.

The presence of HIV in the body can be completely invisible for 10-12 years. The only thing that can bother a person is a slight increase in lymph nodes. When the number of CD-4 cells (those same T-helper cells) decreases sharply, specific diseases associated with immunodeficiency appear. Such diseases are frequent pneumonia, cytomegalovirus infection, herpes. In patients at this stage, such infections quickly become generalized (common) 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, an HIV blood test is offered to all women three times during pregnancy. Tests cannot be ordered without the consent of the patient. But you need to understand that the sooner the correct diagnosis is made, the more chances the patient has to live a long life and give birth to a healthy child, even being a carrier of HIV. The doctor observing the pregnant woman is obliged to tell her about this, he must also explain the benefits of timely diagnosis of HIV in pregnant women.

The most common method for diagnosing HIV infection is 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 results. A false-negative ELISA result is possible with fresh infection, while antibodies to HIV have not yet been developed 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 with more sensitive methods.

The 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 number is referred to as the "viral load". Viral load indicates how active the virus is in the blood. PCR, as well as ELISA, can give a false positive result. Therefore, when obtaining positive results, in addition to the methods listed, other diagnostic methods are also used.

After the diagnosis of HIV infection is made, a further examination of the patient is carried out, during which the nature of the course of the disease and the degree of immunity damage are specified. The degree of immune damage is assessed by the level of CD-4 cells in the blood.

The course of pregnancy

Pregnancy does not accelerate the progression of HIV infection in women who are at an early stage of the disease. The number of pregnancy complications in such women is not much higher than in women without HIV. Slightly more frequent are cases of bacterial pneumonia. There are no significant differences in mortality and the incidence of AIDS among HIV-infected women who have and have not had a pregnancy.

At the same time, in the presence of pregnancy at the stage of AIDS, complications of pregnancy are much more common. These include more frequent and severe bleeding, anemia, preterm labor, stillbirth, low birth weight, chorioamnionitis, postpartum endometritis (inflammation of the lining of the uterus). In general, the more severe the disease, the higher its stage, the more likely complications of pregnancy.

Congenital HIV infection

Mother-to-child transmission of HIV is an established fact. In the absence of special antiviral therapy, infection of children occurs 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 skin of the fetus during childbirth.

Transmission of HIV can occur in three ways: transplacental, during childbirth or after childbirth through mother's milk. The placenta normally protects the fetus from bacteria and viruses found in 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 infant is exposed to the mother's blood and vaginal secretions. Unfortunately, caesarean section is also not a reliable protection of the fetus from HIV infection; its use is justified when a large number of viruses are detected.

The third route of transmission of 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, as children are born with their mothers' antibodies. Maternal antibodies disappear from the baby's blood between 12 and 24 months. It is through this time that it is possible to judge with certainty whether the infection of the child has occurred. PCR diagnostics helps to determine the child's HIV status earlier. Already 4 weeks after birth, the reliability of PCR is 90%, and after 6 months - 99%.

The likelihood of an HIV-positive diagnosis in children can also be indicated by certain diseases of the newborn: 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 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 duration of such a period in adults.

Treatment during pregnancy

In non-pregnant women, the decision to start antiviral therapy is made on the basis of two tests: the level of CD-4 cells and viral load.

Modern treatment requires combination therapy - the simultaneous use of two, three or more antiviral drugs. One drug for the treatment of HIV infection is now used only in one case - in pregnant women, to prevent transmission of HIV to the newborn.

If a woman has taken combination antiviral therapy before pregnancy, then doctors usually recommend that she take a break in treatment for the first three months of pregnancy. This reduces the risk of developing malformations in the unborn child, and in addition, to avoid 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 of 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 been found only as a congenital defect. In contrast to the immunodeficiency of newborns, in these patients, a decrease in immunity was acquired in adulthood. Therefore, the disease in the first years after its discovery began to be called AIDS - acquired immune deficiency syndrome.

Discordant couples, where one partner is HIV positive and the other is not, are not uncommon today. Using a condom with every sexual intercourse, you can be sure that infection will not occur, but it will also not work to get pregnant. In the event that a woman is infected and a man is healthy, everything is quite simple: you need to collect sperm and perform artificial insemination. But if a healthy woman wants to get pregnant from an HIV-infected woman, the situation becomes more complicated, but there are several ways.

Reducing the risk of HIV transmission during conception

Children with HIV can only be born from HIV-infected mothers, the status of the father does not matter, so the main thing is not to infect a woman, but it is quite possible to achieve this. The fact is that the risk of sexual transmission of the virus is not so great, and if desired, it can be reduced to almost zero.

To do this, both partners must contact the infectious diseases center of the AIDS center and tell that they are planning a pregnancy. An infectious disease specialist may suggest that the couple start taking special antiretroviral drugs. Men - to reduce viral load, women - to reduce the risk of infection. After drinking a course of pills, you can have unprotected sex, but it is better to do it as little as possible - on the days of ovulation. If pregnancy has occurred, the first step is to find out if infection has occurred. HIV can only be completely eliminated after a window period of three months has elapsed. Thereafter, a condom must be used with every intercourse until the end of the pregnancy.

Sperm cleaning from HIV

Unlike the previous method, cleaning sperm from HIV protects the expectant mother from infection by 100%. The fact is that the spermatozoa themselves do not contain the virus, it is present only in the seminal fluid. In order to purify the sperm in the laboratory, the spermatozoa are separated from the seminal fluid, after which the egg is artificially fertilized.

Unfortunately, the purification of sperm from HIV is a complex procedure that requires special equipment, which is not available in Russia. At the moment, sperm purification is only done in a few European countries, and it is not cheap.

Pregnancy due to HIV infection

When deciding to give birth from an HIV-infected person, it is important to remember that even if a woman becomes infected at conception, she has every chance of giving birth to a healthy child. The main thing is to diligently follow all the recommendations of the doctor. In this case, the risk of vertical transmission of HIV infection does not exceed 2%.