Impact of HIV infection on pregnancy. Pregnancy with HIV infection

HIV is a relatively recent disease. Mankind met him about 30 years ago, but during this time the number of people infected with the virus has increased significantly. In total, there are more than 40 million people in the world suffering from this disease. The infection introduces many restrictions into the way of life of patients, and can affect the health of future children. Are HIV and pregnancy compatible?
The possible risks in this situation should not be underestimated, but the chance of having a healthy baby remains.

But planning and managing pregnancy in an HIV-positive woman is not an easy task, which requires the joint efforts of an obstetrician-gynecologist, an infectious disease specialist and, of course, the expectant mother herself.

There are two types of human immunodeficiency virus, HIV-1 and HIV-2. The first is more common and often turns into AIDS.

Both types of viruses are embedded in the DNA of cells and are currently incurable. Carrying an infection does not mean that a person will immediately begin to feel the manifestations of the disease. From infection to the transition of HIV to AIDS can take about 10 years.

The virus is transmitted from an infected person through:

• blood, for example, when transfused or using a single syringe;
• seminal fluid and vaginal discharge;
• breast milk.

Therefore, they can be transmitted sexually and when the blood of an infected person comes into contact with an open wound. HIV during pregnancy is dangerous because it can cross the placental barrier.

It is possible that the child is infected from the mother during gestation, it can also occur during childbirth and during breastfeeding.

Those most at risk of infection are people with drug addiction who use psychotropic substances intravenously, homosexuals, and those who are promiscuous without using drugs. But even well-to-do people can be infected.

The risk of “catching” HIV, albeit small, is present when carrying out various medical and cosmetic procedures associated with contact with blood, non-sterile instruments.

How does HIV infection affect the human body?

Once in the body, the virus is embedded in T-lymphocytes (white blood cells responsible for the immune system).

HIV uses the DNA of the cells to reproduce itself, causing them to die. So, many new particles of the virus appear in the body, and the immune system weakens.

With a significant decrease in the number of T-lymphocytes, a person cannot cope with conditionally pathogenic microorganisms.

Because of this, usually harmless bacteria become the cause of serious diseases. At this stage, the patient should start antiretroviral therapy, otherwise there is a risk of dying due to concomitant complications - meningitis, pneumonia, etc.

Symptoms and stages of the disease

The manifestations of the disease depend on how advanced it is. There are the following stages of progression of HIV infection:

1. incubation period. At this time, there are no symptoms, the patient may not be aware of the problem. Timely detection of the virus depends on whether a person monitors his health and whether he passes tests.
2. Stage of primary manifestations. The infected person develops a fever, lymph nodes increase. Colds are becoming more frequent, often with complications. The primary symptoms of HIV during pregnancy, such as chills, headache, fatigue, diarrhea, are easily confused with signs of other diseases. Therefore, the expectant mother needs to report her ailments to the doctor and undergo all the prescribed tests.
3. Generalized damage to the body. Viral, fungal or bacterial infections develop that affect the internal organs. The risk of developing malignant neoplasms increases.
4. Terminal stage. All body systems begin to fail, as a result, the patient dies from infections or tumors.

The duration of the passage of an infected person through these stages is individual. The average period from the moment of infection to the first manifestations of the disease is several years. Cases have been recorded when the first symptoms of the disease appeared within a year and even for a shorter period.

From the moment of infection to severe damage to the body, about 10 years pass, although the disease can be stopped at an early stage, if the patient follows the doctor's prescriptions.

Are pregnancy and HIV compatible? If we are talking about the first two stages, properly selected therapy makes it possible to endure and give birth to a healthy child, although there is no one hundred percent guarantee of this.

But with a rapidly progressing virus, conception is unlikely and irrational due to the serious condition of the woman.

How is HIV diagnosed?

The presence of the virus in the blood of a pregnant woman during the period of bearing a child is checked three times. For this, enzyme immunoassay is performed.

Multiple diagnostics is necessary, because the results of the study are not always reliable for a woman “in position”. Both false-negative and false-positive HIV testing during pregnancy is possible.

The reason that the virus will not be detected is a recent infection in which antibodies have not yet appeared.

A false positive result may be due to the presence of a woman's chronic diseases and malfunctions of the immune system. Therefore, even if the analysis indicates an HIV infection, doctors will not immediately scare the expectant mother, but will prescribe additional examinations.

Only monitoring the indicators in dynamics allows you to accurately determine whether a woman has a virus or not.

The risk of acquiring a child with HIV in pregnant women

If a woman is still diagnosed with HIV during pregnancy and the diagnosis is confirmed, the prognosis is affected by whether she receives the necessary therapy. In the absence of medical support, the probability of infection of a child during gestation and childbirth is 20-40%.

In the case of adequately selected and timely antiretroviral therapy, the chances of having a healthy baby increase. In infected women who are undergoing treatment and who refuse to breastfeed, from 2 to 8% of children receive the virus from the mother.

The baby is more likely to remain healthy if, having donated blood for HIV during pregnancy, the mother was able to identify the disease at an early stage.

Planning for pregnancy with HIV

A woman who knows about her positive status should approach conception deliberately. Pregnancy and HIV therapy in an infected mother go hand in hand. In preparation for conception, a woman needs to take a blood test to determine the viral load.

If the figures are high, first you need to achieve normalization of the number of lymphocytes and a decrease in HIV activity.

In the AIDS center where the expectant mother is seen, specialists will select the necessary therapy.

If the viral load is low and the woman has not recently received HIV treatment, it is recommended to refrain from taking antiviral drugs during the planning period and the first 3 months after conception.

Conception with HIV infection

In a couple where only one partner is infected, sexual intercourse must be carried out using a condom, so conceiving a child is difficult. If both parents have the virus, this simplifies the situation.

But even in this case, sexual intercourse without a condom is not always possible. Open sex is not recommended if partners have different strains of HIV. Overinfection may occur, which will not benefit the health of the parents.

So how do you combine HIV infection and pregnancy? When a woman is infected, for the safe conception of a child, the husband's sperm is collected in a sterile vessel. Then, the seed is used for fertilization, introducing it to the future mother artificially, under medical conditions.

If only the man is sick, there are several solutions. Since the concentration of HIV in seminal fluid is high, conception through unprotected intercourse is dangerous for a woman.

First way- achieve a decrease in the man's viral load to a minimum and try to get pregnant during this period in a natural way. The risk of infection remains, but it can be reduced by having intimacy without a condom only on ovulation days.

After all, the less unprotected sex, the higher the chances of avoiding infection.

Second way- use reproductive technologies and purify the sperm of a man in a special apparatus, separating the spermatozoa from the seminal fluid containing the virus.

There is also the possibility of fertilizing a woman with a donor's seed. But, for obvious reasons, not all couples decide on this. After all, it is important for many that the child is a continuation of a loved one.

How to control the virus during pregnancy?

Every mother who wishes her baby a happy future thinks about what to do if HIV and pregnancy are detected at the same time, and how to give birth to a healthy child.

All women with diagnosed disease should receive antiretroviral therapy consisting of Zidovudine or its combination with Nevirapine starting in the second trimester.

The following measures are also taken to prevent infection of the fetus:

1. Observation at the gynecologist and regular monitoring of the condition of the pregnant woman to minimize the risk. This is necessary because a premature baby, especially those born before 34 weeks, is more likely to become infected.
2. Prevention of diseases associated with HIV and their complications.
3. Exclusion of perinatal invasive diagnostics.
4. Planning for delivery. In most cases, a woman is shown planned. But if the viral load does not exceed 1000 in 1 µl, natural childbirth is allowed. At the same time, they try to avoid any obstetric surgical procedures - opening the fetal bladder, perineal incisions, etc.

Therapy for HIV during pregnancy, further rejection of breastfeeding and the appointment of a prophylactic course of antiviral drugs to the newborn, minimize the risk of infection.

It is impossible to understand whether a child is infected immediately after birth. Due to the ingestion of antibodies from the mother into his blood, tests for HIV in a baby can be positive up to 1.5 years. If after this period they disappear - the child is healthy.

HIV prevention in pregnant women

In order to prevent the virus in expectant mothers, it is recommended that a couple be tested for HIV before conception, as well as be examined for other infections. Upon learning of pregnancy, a woman needs to contact a gynecologist.

Early registration and timely examinations minimize the risk of complications and leave time to decide whether it is advisable to continue gestation when a dangerous disease is detected.

Pregnancy and HIV infection put a woman in front of a difficult choice. Despite all the achievements of medicine, there is no guarantee of the birth of a healthy child, so a gynecologist may recommend an abortion. It is up to the parents to agree to this or not. Doctors are obliged to support any of their choices.

If you have an HIV test positive during pregnancy, this is not a reason to panic. To establish the diagnosis, an additional examination at the AIDS center is required, because erroneous results are not uncommon.

Even if in the end the presence of the virus is confirmed, this is not a sentence, but a reason to urgently start treatment. People with HIV who are on antiretroviral therapy and are mindful of their health can live full lives.

Useful video: woman, child and HIV (doctors' opinion)

Most HIV positive women want to have children. Modern methods of medical intervention in the prenatal and childbirth period help to reduce the risk of transmission of HIV infection from mother to child to almost zero. Still, any HIV-positive woman should weigh the pros and cons before taking this step.

There is no evidence that pregnancy accelerates the course of HIV infection in asymptomatic women. Therefore, it makes sense for an HIV-positive woman who wants to become pregnant to seek the necessary information and seek advice. Knowledge about mother-to-child transmission is evolving rapidly. It is becoming increasingly clear that some situations are better suited for conception than others in order to minimize (but not eliminate) the risk of HIV transmission to the fetus.

Some worry that a child (even if not infected) may be orphaned (due to the death of one or both parents) until reaching adulthood. It is important that the mother (and her partner, if that matters) make the decision herself, and not shift it to the shoulders of the medical profession. For HIV-positive women taking combination treatment, it is important to discuss conception (or contraception) with a medical or other professional. If possible, this discussion should take place before conception.

Some women want to stop treatment either before pregnancy or when they realize they are pregnant. This issue needs to be discussed in detail. As a rule, it is important that the woman continues the course of treatment. If treatment is stopped, there is a risk of a rapid recovery of the viral load, and this may increase the risk of so-called vertical transmission. There is also concern about the risk of abnormal fetal development, although today the only evidence of side effects is the risk of preterm birth in mothers undergoing dual or triple therapy.

Problems of HIV-positive women who want to get pregnant from HIV-negative men

During unprotected intercourse, there is a small risk of infection of the male partner. This can be avoided if the woman uses a self insemination kit. In this simple procedure, a woman inseminates herself at the time of ovulation with her partner's sperm collected in a sterile vial. Most hospitals and women's health organizations can offer advice and equipment.

Problems of HIV-negative women who want to get pregnant from HIV-positive men

Transmission to the child occurs when the virus is passed from an infected mother to the child in the womb, during childbirth or breastfeeding. If the father is HIV-positive and the mother is not, the child will not be directly infected through the father's semen. If a woman becomes infected at the time of conception, there is a significant risk of transmission to the baby because the woman's viral load is likely to be high at the time of seroconversion. Although there have been cases where women have become pregnant by HIV-positive men and have not become infected, there is no reliable information explaining why this became possible.

Some couples who want to conceive can try to minimize the woman's risk of becoming infected by having unprotected sex only when the chances of getting pregnant are high and the possibility of HIV infection is low. This happens around the time a woman is ovulating, or when her partner's viral load is undetectable. However, the theory that the risk of HIV transmission decreases during this period has not yet been proven.

Sperm cleansing

One option is to cleanse the sperm. Spermatozoa do not contain CD4 or CCR5 receptors, which may allow HIV infection, although they may contain CXCR4 receptors, which may allow HIV entry.

A semen sample can be "purified" by separating the semen from the seminal fluid; after that, the sperm is placed in an incubator, where the live sperm is separated from the dead, and after that it can be used for insemination. This method is effective for men whose semen has an average or high sperm count. The results of a study of 11 HIV-positive men showed that this separation technique reduced the viral load to the point where the virus was not detected (although this does not exclude the presence of HIV in very low numbers), and the inserted viral DNA was not detected in semen samples.

No cases of HIV transmission to female partners have been reported using this method. According to the Italian group that first started using the method, 1,000 attempts at insemination were made in a group of 350 couples, resulting in 200 women getting pregnant. The method is currently being studied at the Chelsea and Westminster hospitals in London.

A woman who wishes to conceive a child in this way will be monitored to determine when ovulation begins, after which the partner must provide sperm for cleaning prior to HIV testing. If the sample is negative, you can start artificial insemination. Chelsea and Westminster hospitals warn couples who wish to use this method that even after cleaning, about 5-6% of samples remain HIV-positive (which test results confirm). It should also be recalled that this procedure is not free.

Artificial insemination

Another option for an HIV-negative woman whose partner is infected may be artificial insemination with the sperm of another man - an anonymous donor or someone known to both partners (for example, a family member of the male partner). This option is used by many women whose husbands are infertile, who can pass on an infection or congenital diseases.

Problems of HIV-positive couples

If both partners are HIV positive, unprotected sex can pose health risks to the woman, such as contracting STIs or other strains of HIV. If each partner, or both partners, are treated in combination, there is a theoretical risk of transmission of drug-resistant strains of the virus between spouses, or to the child if he is also infected. This may limit treatment options for family members in the future. However, the main (and proven) danger remains the risk of transmitting HIV to the fetus. It is very important that medical professionals discuss the problems of conceiving children with such couples.

Problems of continuation of pregnancy in case of detection of HIV-positive status

Women who find out during pregnancy that they are infected with HIV have a lot of information to think about and make important decisions fairly quickly. In order to make these decisions, it is important to give women enough time, accurate information and good support, and the opportunity to explore all possible options. Whatever decisions they make, the results can be either positive or negative. Women who knew their HIV status before conception should consider the following questions.

Vertical transmission risk

Based on the results of current research, the baby will remain negative in six out of seven cases (in one case in seven it will be positive, and this probability can be reduced even more by receiving antiretroviral therapy, caesarean section and artificial feeding of the child). The key transmission factors are maternal viral load, CD4 cell count, and overall progression of HIV disease.

Studies have shown that HIV can be transmitted to a fetus even as early as 8 weeks because it has been found in aborted fetuses. However, researchers are confident that, in general, the transmission of the virus occurs in late pregnancy or around the time of childbirth. This belief is partly based on the fact that some infants did not show signs of HIV infection at birth, suggesting that they were infected just before birth or during delivery. There are three periods during which an infected mother can pass the virus to her baby.

The period of gestation

During pregnancy, a mother can pass the virus from her bloodstream through the placenta to her fetus. The placenta is the organ that connects mother and fetus during pregnancy. The placenta allows nutrients from the mother's body to reach the fetus, and normally protects the fetus from infectious agents such as HIV in the mother's blood. However, if the placental membrane is inflamed or damaged, it is no longer as effective in protecting against the entry of viruses. In this case, HIV infection can be transmitted from mother to fetus. Factors that increase or change the risk of antenatal transmission of the virus during gestation:

• high maternal viral titer (the amount of virus in the mother's blood);
• maternal neutralizing antibodies (maternal antibodies can inactivate HIV in the fetus);
• inflammation of the placental membrane (in this case, it is not so effective against the penetration of the virus);
• conditions during childbirth leading to increased exposure of the fetus to maternal blood
• (early separation of the placenta from the uterus, damage to the baby's skin (obstetric forceps);
• for drug addiction: sharing drug needles during pregnancy;
• other infectious diseases (other infections weaken the mother's immune system, which increases the child's risk of HIV infection).

birth period

During passage through the birth canal, the infant is exposed to the blood and vaginal secretions of the infected mother. Early separation of the placenta from the mother's uterus, as well as anything that causes damage to the baby's skin (such as the use of obstetric forceps) can lead to increased exposure of the baby to maternal blood.

postpartum period

After giving birth, a mother can pass the virus on to her baby while breastfeeding. Several factors may contribute to this:

• breast milk is the main food of the newborn, which is quite rich in leukocytes, including CD4 cells;
• the gastrointestinal tract of the newborn is not perfect and actively absorbs albumins;
• while breastfeeding, the baby may be exposed to blood if the mother has an injury to the skin around the nipple.

The above options for reducing the risk of transmission to the baby are intended to reduce the mother's viral load and minimize the baby's exposure to infected maternal body fluids, such as cervical or vaginal secretions, blood, and breast milk. If a woman takes all these precautions, it is possible to reduce the risk to a great extent. However, the risks associated with ART and caesarean section, both for mother and child, exist and should be discussed. The long-term effects of taking strong drugs in an HIV-negative child are still unknown. In addition, the emotional and cultural importance of breastfeeding to some mothers cannot be underestimated.

Possibility of abortion

A woman must understand that she has a strictly defined time to decide, and understand what this is connected with. For example, there is a significant difference between early and late pregnancy terminations. Unfortunately, a woman who is being tested at a antenatal clinic will not be able to find out the result until the gestational age reaches 14 weeks. This may mean a late termination of pregnancy with the help of artificial childbirth. And what does she herself think about the interruption? Does she have certain religious beliefs that might influence her decision? What kind of support will she be able to get if she has an abortion? HIV-positive women who decide to terminate a pregnancy need extensive help and counseling. Just like other women who have recently had an abortion, they should not be offered immediate sterilization. This is a contraceptive measure, a decision likely to be regretted and should not be considered before the woman has come to terms with the trauma of termination of pregnancy and information about HIV status, especially if it is only recently identified.

If this pregnancy is terminated, what are the chances of getting pregnant again? How important is it for this woman to have children? Does she have other children? Does her partner (if any) know her HIV status? What does he think about the continuation of the pregnancy? What kind of support can you offer? Has he tested himself? Does he want to be tested? What support will she receive if she continues the pregnancy? What could this mean for her future? Who will take care of the baby if she or her partner is not feeling well? How will they cope with their illness?

This is a chronic progressive infectious disease caused by a pathogen from the group of retroviruses and occurred before the conception of a child or during the gestational period. A long time passes latently. In the primary reaction, it is manifested by hyperthermia, skin rash, mucosal lesions, transient enlargement of the lymph nodes, and diarrhea. Subsequently, generalized lymphadenopathy occurs, weight gradually decreases, and HIV-associated disorders develop. Diagnosed by laboratory methods (ELISA, PCR, cellular immunity study). Antiretroviral therapy is used to treat and prevent vertical transmission.

HIV infection is a strict anthroponosis with a parenteral non-transmissible mechanism of infection from an infected person. Over the past 20 years, the number of newly diagnosed infected pregnant women has increased by almost 600 times and exceeded 120 per 100,000 examined. Most women of childbearing age were infected through sexual contact, the proportion of HIV-positive patients with drug addiction does not exceed 3%. Due to the observance of the rules of asepsis, sufficient antiseptic processing of instruments for invasive procedures and effective serological control, it was possible to significantly reduce the incidence of infection as a result of occupational injuries, blood transfusions, due to the use of contaminated instruments and donor materials. In more than 15% of cases, it is not possible to reliably determine the source of the pathogen and the mechanism of infection. The relevance of special support for HIV-infected pregnant women is due to the high risk of infection of the fetus in the absence of adequate restraining treatment.

The reasons

The causative agent of the disease is a human immunodeficiency retrovirus of one of two known types - HIV-1 (HIV-1) or HIV-2 (HIV-2), represented by many subtypes. Usually, infection occurs before the onset of pregnancy, less often - at the time or after the conception of a child, during gestation, childbirth, and the postpartum period. The most common route of transmission of an infectious agent in pregnant women is natural (sexual) through the mucous secretion of an infected partner. Infection is possible with the intravenous administration of narcotic drugs, violation of aseptic and antiseptic standards during invasive manipulations, performance of professional duties with the possibility of contact with the blood of a carrier or patient (health workers, paramedics, cosmetologists). During pregnancy, the role of some artificial ways of parenteral infection increases, and they themselves acquire certain specifics:

• Blood transfusion infection. With a complicated course of pregnancy, childbirth and the postpartum period, the likelihood of blood loss increases. Treatment regimens for the most severe bleeding involve the introduction of donor blood and preparations derived from it (plasma, erythrocyte mass). HIV infection is possible when using material tested for the virus from an infected donor in case of blood sampling during the so-called seronegative incubation window, which lasts from 1 week to 3-5 months from the moment the virus enters the body.
• instrumental infection. Pregnant patients are more likely than non-pregnant patients to undergo invasive diagnostic and therapeutic procedures. To exclude abnormalities in the development of the fetus, amnioscopy, amniocentesis, chorion biopsy, cordocentesis, placentocentesis are used. For diagnostic purposes, endoscopic examinations (laparoscopy) are performed, for therapeutic purposes - suturing of the cervix, fetoscopic and fetal drainage operations. Infection through contaminated instruments is possible during childbirth (when suturing injuries) and during caesarean section.
• Transplant transmission of the virus. Possible solutions for couples planning a pregnancy with severe forms of male infertility are insemination with donor sperm or its use for IVF. As in the case of blood transfusions, in such situations there is a risk of infection when using infected material obtained during the seronegative period. Therefore, for prophylactic purposes, it is recommended to use the sperm of donors who have successfully passed an HIV test six months after the donation of the material.

Pathogenesis

The spread of HIV throughout the body occurs with the blood and macrophages, into which the pathogen is initially introduced. The virus has a high tropism for target cells, the membranes of which contain a specific protein receptor CD4 - T-lymphocytes, dendritic lymphocytes, parts of monocytes and B-lymphocytes, resident microphages, eosinophils, cells of the bone marrow, nervous system, intestines, muscles, vascular endothelium, choriontrophoblast of the placenta, possibly spermatozoa. After replication, a new generation of the pathogen leaves the infected cell, destroying it.

Immunodeficiency viruses have the greatest cytotoxic effect on type I T4 lymphocytes, which leads to depletion of the cell population and disruption of immune homeostasis. A progressive decrease in immunity worsens the protective characteristics of the skin and mucous membranes, reduces the effectiveness of inflammatory reactions to the penetration of infectious agents. As a result, in the final stages of the disease, the patient develops opportunistic infections caused by viruses, bacteria, fungi, helminths, protozoal flora, tumors typical of AIDS (non-Hodgkin's lymphomas, Kaposi's sarcoma), autoimmune processes begin, eventually leading to the death of the patient.

Classification

Domestic virologists use in their work the systematization of the stages of HIV infection proposed by V. Pokrovsky. It is based on the criteria of seropositivity, the severity of symptoms, the presence of complications. The proposed classification reflects the gradual development of infection from the moment of infection to the final clinical outcome:

• Incubation stage. HIV is present in the human body, it is actively replicating, but antibodies are not detected, there are no signs of an acute infectious process. The duration of seronegative incubation is usually from 3 to 12 weeks, while the patient is contagious.
• Early HIV infection. The primary inflammatory response of the body to the spread of the pathogen lasts from 5 to 44 days (in half of the patients - 1-2 weeks). In 10-50% of cases, the infection immediately takes the form of asymptomatic carriage, which is considered a more favorable prognostic sign.
• Stage of subclinical manifestations. Virus replication and destruction of CD4 cells lead to a gradual increase in immunodeficiency. A characteristic manifestation is generalized lymphadenopathy. The latent period in HIV infection lasts from 2 to 20 years or more (on average, 6-7 years).
• Stage of secondary pathology. The depletion of protective forces is manifested by secondary (opportunistic) infections, oncopathology. The most common AIDS-indicator diseases in Russia are tuberculosis, cytomegalovirus and candidal infections, pneumocystis pneumonia, toxoplasmosis, and Kaposi's sarcoma.
• Terminal stage. Against the background of severe immunodeficiency, pronounced cachexia is noted, there is no effect from the therapy used, the course of secondary diseases becomes irreversible. The duration of the final stage of HIV infection before the death of the patient is usually no more than a few months.

Practicing obstetricians and gynecologists often have to provide specialized care to pregnant women who are in the incubation period, at an early stage of HIV infection or its subclinical stage, less often when secondary disorders appear. Understanding the characteristics of the disease at each stage allows you to choose the optimal scheme for managing pregnancy and the most appropriate method of delivery.

HIV symptoms in pregnant women

Since during pregnancy in most patients stage I-III of the disease are determined, pathological clinical signs are absent or look non-specific. During the first three months after infection, 50-90% of those infected have an early acute immune reaction, which is manifested by weakness, slight fever, urticarial, petechial, papular rash, inflammation of the mucous membranes of the nasopharynx, vagina. Some pregnant women have swollen lymph nodes and develop diarrhea. With a significant decrease in immunity, short-term, mild candidiasis, herpes infection, and other intercurrent diseases may occur.

If HIV infection occurred before pregnancy, and the infection has developed to the stage of latent subclinical manifestations, the only sign of the infectious process is persistent generalized lymphadenopathy. A pregnant woman has at least two lymph nodes with a diameter of 1.0 cm or more, located in two or more groups that are not interconnected. When touched, the affected lymph nodes are elastic, painless, not connected to the surrounding tissues, the skin over them has an unchanged appearance. The increase in nodes persists for 3 months or more. Symptoms of secondary pathology associated with HIV infection are rarely detected in pregnant women.

Complications

The most serious consequence of pregnancy in an HIV-infected woman is perinatal (vertical) infection of the fetus. Without adequate restraining therapy, the probability of infection of the child reaches 30-60%. In 25-30% of cases, the immunodeficiency virus passes from mother to child through the placenta, in 70-75% - during childbirth when passing through an infected birth canal, in 5-20% - through breast milk. HIV infection in 80% of perinatally infected children develops rapidly, and AIDS symptoms appear within 5 years. The most characteristic signs of the disease are malnutrition, persistent diarrhea, lymphadenopathy, hepatosplenomegaly, developmental delay.

Intrauterine infection often leads to damage to the nervous system - diffuse encephalopathy, microcephaly, cerebellar atrophy, deposition of intracranial calcifications. The likelihood of perinatal infection increases with acute manifestations of HIV infection with high viremia, a significant deficiency of T-helpers, extragenital diseases of the mother (diabetes mellitus, cardiopathology, kidney disease), the presence of sexually transmitted infections in a pregnant woman, chorioamnionitis. According to obstetrics specialists, HIV-infected patients are more likely to have a threatened miscarriage, spontaneous miscarriages, premature births, and increased perinatal mortality.

Diagnostics

Taking into account the potential danger of the patient's HIV status for the unborn child and attending medical personnel, the test for the immunodeficiency virus is included in the list of recommended routine examinations during pregnancy. The main tasks of the diagnostic stage are to identify possible infection and determine the stage of the disease, the nature of its course, and prognosis. For diagnosis, the most informative laboratory methods of research:

• Linked immunosorbent assay. Used for screening. Allows you to detect antibodies to the human immunodeficiency virus in the blood serum of a pregnant woman. Negative in the seronegative period. It is considered a method of preliminary diagnosis, it requires confirmation of the specificity of the results.
• immune blotting. The method is a kind of ELISA, which makes it possible to determine in the serum antibodies to certain antigenic components of the pathogen, distributed by molecular weight by phoresis. It is a positive immunoblot result that is a reliable sign of the presence of HIV infection in a pregnant woman.
• PCR diagnostics. Polymerase chain reaction is considered a method of early detection of the pathogen with a period of infection of 11-15 days. With its help, viral particles are determined in the patient's serum. The reliability of the technique reaches 80%. Its advantage is the possibility of quantitative control of copies of HIV RNA in the blood.
• Study of the main subpopulations of lymphocytes. The probable development of immunosuppression is evidenced by a decrease in the level of CD4-lymphocytes (T-helpers) to 500/µl or less. The immunoregulatory index, which reflects the ratio between T-helpers and T-suppressors (CD8-lymphocytes), is less than 1.8.

When a previously unexamined pregnant woman from marginal contingents is admitted for childbirth, it is possible to conduct an express HIV test using highly sensitive immunochromatographic test systems. For a planned instrumental examination of an infected patient, non-invasive diagnostic methods are preferred (transabdominal ultrasound, dopplerography of the uteroplacental blood flow, cardiotocography). Differential diagnosis at the stage of early reaction is carried out with ARVI, infectious mononucleosis, diphtheria, rubella, and other acute infections. If generalized lymphadenopathy is detected, it is necessary to exclude hyperthyroidism, brucellosis, viral hepatitis, syphilis, tularemia, amyloidosis, lupus erythematosus, rheumatoid arthritis, lymphoma, and other systemic and oncological diseases. According to the indications, the patient is consulted by an infectious disease specialist, a dermatologist, an oncologist, an endocrinologist, a rheumatologist, a hematologist.

Treatment of HIV infection in pregnant women

The main objectives of pregnancy management in case of infection with the human immunodeficiency virus are infection suppression, correction of clinical manifestations, and prevention of infection of the child. Depending on the severity of symptoms and the stage of the disease, massive polytropic therapy with antiretroviral drugs is prescribed - nucleoside and non-nucleoside reverse transcriptase inhibitors, protease inhibitors, integrase inhibitors. Recommended treatment regimens differ at different gestational ages:

• When planning a pregnancy. To avoid embryotoxic effects, women with HIV-positive status should stop taking special drugs before the onset of a fertile ovulatory cycle. In this case, it is possible to completely eliminate the teratogenic effect in the early stages of embryogenesis.
• Up to 13 weeks pregnant. Antiretroviral drugs are used in the presence of secondary diseases, a viral load exceeding 100 thousand copies of RNA / ml, a decrease in the concentration of T-helpers less than 100 / μl. In other cases, pharmacotherapy is recommended to be discontinued to exclude negative effects on the fetus.
• 13 to 28 weeks. When diagnosing HIV infection in the second trimester or when an infected patient is treated at this time, active retroviral therapy is urgently prescribed with a combination of three drugs - two nucleoside reverse transcriptase inhibitors and one drug from other groups.
• From 28 weeks to delivery. Antiretroviral treatment continues, chemoprevention of the transmission of the virus from a woman to a child is being carried out. The most popular scheme is in which, from the beginning of the 28th week, the pregnant woman constantly takes zidovudine, and once before childbirth - nevirapine. In some cases, backup schemes are used.

The preferred method of delivery for a pregnant woman diagnosed with HIV infection is vaginal delivery. When they are carried out, it is necessary to exclude any manipulations that violate the integrity of tissues - amniotomy, episiotomy, obstetric forceps, use of a vacuum extractor. Due to a significant increase in the risk of infection of the child, the use of drugs that cause and enhance labor activity is prohibited. A caesarean section is performed after 38 weeks' gestation for unknown viral load, viral load greater than 1,000 copies/mL, no antenatal antiretroviral therapy, and inability to administer retrovir during labor. In the postpartum period, the patient continues to take the recommended antiviral drugs. Since breastfeeding is prohibited, lactation is suppressed with medication.

Forecast and prevention

Adequate prevention of HIV transmission from pregnant woman to fetus can reduce the level of perinatal infection to 8% or less. In economically developed countries, this figure does not exceed 1-2%. Primary prevention of infection involves the use of barrier contraceptives, sexual life with a permanent verified partner, refusal to use injecting drugs, the use of sterile instruments when performing invasive procedures, and careful control of donor materials. To prevent infection of the fetus, it is important to timely register an HIV-infected pregnant woman with a antenatal clinic, refuse invasive prenatal diagnostics, choose the optimal antiretroviral treatment regimen and method of delivery, and prohibit breastfeeding.

In the issue of giving birth or not giving birth to a child, the last word always remains with the woman. This also applies to situations where the health of the unborn baby is threatened by HIV. Before deciding on such a responsible step, it is necessary to carefully weigh all the pros and cons, be sure to consult a doctor. Information about the transmission of the infection to the child and the possibilities to give birth to a healthy child is constantly updated with new facts, so the advice of a specialist will be quite useful.

A woman may be declared such a diagnosis after a blood test. This can be a real shock for a pregnant woman. A few years ago, an HIV diagnosis meant an abortion. It has now been proven that even an HIV-positive mother can give birth to an absolutely healthy child. Medicine is constantly exploring ways to reduce the risk of infection in the baby.

A pregnant woman who hears an HIV diagnosis must decide the fate of her pregnancy in a short time. To do this, she must have as much information about the disease as possible. You can get such information only from a doctor, it is better not to rely on the advice of friends and acquaintances in these cases. They may have inaccurate information about HIV disease, exert pressure, persuading them to immediately get rid of the child. All this can negatively affect the psychological state of the expectant mother.

Blood test for HIV during pregnancy

An HIV blood test is mandatory for all pregnant women when they register with the antenatal clinic. It is advisable to take blood for HIV during pregnancy in the morning on an empty stomach. For analysis, about 5 mg of blood is taken from the cubital vein. The results of the analysis are confidential information, so the doctor can only tell the patient personally. In addition to the hospital, there are special Centers for the Prevention and Control of AIDS, where you can donate blood for HIV infection anonymously, without indicating your data. In the same place, you can find out the result in 10-14 days by calling the number indicated during the analysis. AIDS Centers offer expert advice on HIV prevention and treatment.

An HIV test is very important, since the disease proceeds without pronounced symptoms, only a slight swelling of the lymph nodes is possible. An infected pregnant woman can in most cases pass the virus on to her baby. And if she knows about her disease and accepts treatment, the risk of infection of the baby can be minimized. Infection of a newborn can occur during childbirth through contact with blood or amniotic fluid, as well as during breastfeeding.

Therefore, preventive measures are provided, a woman is recommended a caesarean section instead of childbirth, as well as artificial feeding of the baby.

False positive HIV during pregnancy

Every woman planning the birth of a child should know that you cannot believe everything unconditionally. Even if the blood test for HIV during pregnancy is positive, one should not panic and think about the diseases of all subsequent generations. To obtain accurate data, a repeated blood test for HIV is provided. Therefore, in such a situation, the doctor will send for a second test. If the second analysis showed a negative result, the first analysis can be called a false positive. This is not uncommon during pregnancy. Why does this happen?

1. Amazing processes take place in the body of a pregnant woman. The emerging new life consists of 2 genetic materials: maternal and paternal. Sometimes the mother's body produces antibodies to protect against foreign DNA. It is this phenomenon that captures the test for HIV.
2. A false-positive HIV test may indicate chronic diseases in the body of the expectant mother.
3. Regrettably, some people are irresponsible about their work, even laboratory assistants. Perhaps the test tubes with blood were simply mixed up or similar names came across.

Pregnancy with HIV infection

Sometimes a married couple wants to have a baby, already knowing that one or both partners are infected. Couples in which one partner is infected usually use a protective device during sex. To protect the second partner from the virus and conceive a child, special techniques and recommendations have been developed.

Pregnancy and HIV: woman is HIV positive, man is HIV negative

In this case, partners practice only protected sex. The woman should go to the hospital for a consultation. To exclude the possibility of partner infection, it is recommended to use a self-insemination kit. To do this, the partner's sperm is collected in a special container, and on days favorable for conception, the woman independently uses the partner's seminal fluid for fertilization.

Pregnancy and HIV: woman is HIV negative, man is HIV positive

In such a situation, the risk of infection of a woman is high, as well as the transmission of HIV infection to an unborn child through semen. To reduce the risk of infection, partners use unprotected sex only on fertile days. But this does not completely eliminate the risk of infection.

Currently, some well-known clinics offer the latest way to cleanse sperm from HIV infection. This procedure is quite expensive, but it goes as follows. The seminal fluid undergoes a separation process that separates live and dead spermatozoa. This material is preserved until the time of a favorable conception in a woman. The fertilization procedure takes place in a clinic. Just before fertilization, the sperm is tested again for HIV infection. The disadvantage of this method is that it is only suitable for those men whose semen contains a large number of healthy viable spermatozoa.

In some cases, an HIV-negative woman is advised to IVF with the sperm of an anonymous partner so that the couple can have a healthy baby. This method is used in cases of male infertility and severe hereditary diseases in the male family.

Pregnancy and HIV: both partners are HIV positive

The most important danger in this case is the infection of the unborn child. There are also risks of transmission from one partner to another of treatment-resistant strains of the virus. HIV-positive spouses should undergo a full examination and receive specialist advice to minimize the risk of infection of the baby.

HIV and pregnancy: how to have a healthy baby

If a woman knows that she is infected, she should not be afraid that pregnancy will worsen her condition. Complications can be caused by concomitant diseases, as well as bad habits. HIV infection does not affect the intrauterine development of the fetus, its main danger is infection of the baby during birth.

HIV can be transmitted from a sick mother to her child in the following ways:

• in utero;
• during childbirth;
• when breastfeeding.

If an HIV-positive woman does not take any measures to protect her child from the virus, the risk of infection is about 30%. With timely preventive measures started, it can be reduced to 2-3%.

Factors that increase the risk of infection in a child:

• weakened immunity of a pregnant woman;
• high levels of the virus in the blood of an HIV-positive mother;
• breast-feeding;
• early discharge of amniotic fluid, bleeding;
• premature pregnancy;
• multiple pregnancy;
• taking drugs during pregnancy.

If the result for HIV during pregnancy was positive, but the woman decided to become a mother, how to give birth to a child without infecting him with the virus?

1. Follow all the recommendations of doctors, undergo examinations in a timely manner, regularly visit a antenatal clinic.
2. HIV-positive pregnant women are recommended to be treated starting at 3 months of pregnancy. As a rule, drugs are prescribed that are safe for the baby. It is better not to refuse their reception, timely treatment reduces the risk of intrauterine infection of the fetus.
3. Proper nutrition, rejection of bad habits, healthy lifestyle. All these are not empty words, they mean a lot to a developing child. The baby must get the maximum amount of nutrients and gain the necessary weight to resist infections.
4. Prevention of preterm birth. A premature baby has low immunity, which increases the risk of infection.
5. Treatment of chronic diseases in the expectant mother.
6. Planning a caesarean section at 38 weeks. The final decision on the operation is made by the gynecologist, taking into account the condition of the pregnant woman.
7. Refusal of breastfeeding. The milk of an HIV-positive mother contains the virus, therefore, adapted milk formulas are recommended for artificial feeding of a baby.
8. Prophylactic administration of antiviral drugs to newborns.

Each woman has the right to decide for herself how much she needs a child, even if he has a high risk of being born infected. The main thing is that this decision should be thoughtful and balanced, and the born child is desired and loved. Sometimes it is the birth of a child that is an incentive for infected people to assert their rights, as well as carefully monitor their health.

Symptoms and treatment of HIV infection. Video

Petropavlovsk-Kamchatsky, April 30 - AiF-Kamchatka. There are people who themselves are on the verge of death, but doing everything possible to give life to a precious creature. Elena SERZHANTOVA, a pediatrician at the AIDS Center, told the correspondent of AiF-Kamchatka about this.

Chemistry of motherhood

Elena Serzhantova: - Can an HIV positive woman become a mother? Of course yes! The presence of HIV infection is not a contraindication for pregnancy and childbirth. The achievements of modern medicine can significantly reduce the risk of HIV transmission from mother to child, and the birth of a healthy child is quite real.

Of course, to solve this important issue, an HIV-infected woman needs to consult an infectious disease specialist at the AIDS Center and an obstetrician-gynecologist at the antenatal clinic. If there are no contraindications for pregnancy, the expectant mother must register with the antenatal clinic and be observed on a general basis.

"AiF-Kamchatka": - Is it still possible to infect a child?

E.S.: - Yes, especially in late pregnancy, during childbirth and while breastfeeding. The probability of HIV transmission from mother to child without preventive measures is 20-40%. But with the use of modern methods of prevention, the risk of infection is reduced to 1-2%!

The system is as follows: from 22–28 weeks of pregnancy, the first stage of chemoprophylaxis begins - the appointment of antiretroviral drugs to reduce the viral load in the blood of a pregnant woman. In simple words: the less virus in the blood, the less likely it is to cross the placenta to the fetus. A caesarean section is chosen as a method of delivery, it is considered an independent method of prevention - in this case, the contact of the infant with the mother's biological fluids is minimized, in contrast to natural childbirth.

Photo: www.russianlook.com

With the onset of labor, the second stage of chemoprophylaxis begins - the woman stops taking antiviral drugs in tablets, and throughout the entire period of childbirth receives them intravenously.

After the birth of the baby, prevention for the mother ends and begins for the child. Immediately after birth, he is transferred to artificial feeding. Unfortunately, HIV infection in the mother is an absolute contraindication to breastfeeding. From the first hours of life to one and a half months, the child receives an antiviral drug in the form of syrup. This medicine is in most cases well tolerated by babies, without causing side effects.

A newborn child is registered with the AIDS Center from the first day of life. Why is this needed? Doctors cannot immediately say for sure whether the infection was transmitted to him. Therefore, the baby must be systematically monitored for up to one and a half years, and he needs the same regular examination as all children. If a child is diagnosed with HIV infection, then he remains on the dispensary record for life. Otherwise, the child will be removed from the register.

Honest and with love

AiF-Kamchatka: How is HIV diagnosed in newborns?

E.S.: - All children born to HIV-infected mothers have maternal antibodies to HIV proteins in their blood, and the result of a standard test will be positive for them, but this does not mean that the child is necessarily infected with HIV! Gradually, by 12-15 months of life, maternal antibodies in the blood of the child are destroyed. However, HIV infection in children in the first year of life can progress quite quickly, and earlier diagnosis is necessary. This can be done using polymerase chain reaction (PCR) - molecular methods for detecting HIV proteins. The first study is carried out in 1-2 months of life. A positive result in this case with a probability of about 98% indicates HIV infection. Children with negative PCR results at one month of age, 4-6 months of age or older are considered HIV-negative. In addition, each child is examined by a specialist doctor to identify clinical manifestations characteristic of HIV/AIDS.

The child is healthy! Photo by Anastasia Erokhina

Taking into account the results of the studies, taking into account the type of feeding of the child, his age, doctors make a final conclusion about the absence or presence of HIV infection in the child.

The history of the HIV epidemic shows that in many cases, HIV-positive children, receiving good care and timely treatment, feeling the love and care of their parents, live a long and fulfilling life, create families, give birth to healthy children. The main thing is to believe in it and act competently and with love!

"AiF-Kamchatka": - Doctor, are there children in Kamchatka who were born from HIV-infected mothers?

E.S.: - Yes there is. And they are all healthy! Now under our supervision there are nine babies, none of them have been diagnosed with HIV (here the doctor knocked on wood). This is our special pride.

BY THE WAY

HIV-infected children have the same rights as healthy children, including: attending a kindergarten and any children's groups, communicating with peers, being observed and treated in medical institutions on a general basis. HIV is not transmitted by household means!