Can a healthy child be born to HIV-infected parents? HIV virus in children: routes of infection, treatment and how long they live A child of an HIV-infected mother

HIV infection. In my opinion, no other disease causes more fear in potential parents. Most people still perceive an HIV-infected person as a direct threat to life, as a death sentence that is “final and not subject to appeal.” In many ways, this fear is generated by the lack of information about this disease.

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

Among the children in the social system of our region, there are several children with a confirmed diagnosis of HIV+, and significantly more children to whom the disease was not transmitted to their mother, but in their personal files there remains a terrible entry - “HIV contact”, which scares off so many potential parents. Despite this, I would like to note that our situation with placing HIV-contact children and even HIV+ children in families has already moved forward. Potential parents now, unlike, for example, a few years ago, have access to information regarding this disease. Increasingly, quite competent articles and stories appear in the media, the main goal of which is to convey to the audience information about the essence of the disease, about the routes of its transmission, about new achievements in the field of HIV treatment.

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

So, let's begin.
AIDS (acquired immunodeficiency syndrome) is a disease, the consequence of which is a decrease in the body's protective abilities (immunity), and its cause is a sharp decrease in the number of lymphocyte cells, which play a central role in the body's immune system.

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

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

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

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

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

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

Children whose HIV-infected mothers passively transferred antibodies to HIV to them) are considered HIV-contact. They are observed at the AIDS Center and children's clinic at their place of residence, and are tested there. necessary tests, for timely monitoring of whether maternal antibodies are leaving the child’s blood. This condition, according to the International Classification of Diseases (ICD-10), is designated as an inconclusive test for HIV.

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

In accordance with Order No. 606 of the Ministry of Health of the Russian Federation dated December 19, 2003, to deregister a child at the age of 18 months. the following conditions must be present:

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

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

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

HIV + child is NOT INFECTIOUS to others, he does not pose the slightest danger to you, to your natural children, etc. There is no HIV infection in the home. If there was at least one case of infection in this way, there would be no Federal laws, nor orders from the Ministry of Health stating that there are no restrictions when communicating with such people.
HIV+ child can attend kindergarten and school along with all other children, you have the right to non-disclosure of the child’s diagnosis in these institutions. The law protects the secrecy of the diagnosis; in our city, HIV+ children attend kindergartens and schools, and no one has had any problems. In our city, medical care for HIV+ children is organized very well, no one will point a finger at you, every clinic has HIV+ children registered, you will not be the first and the last, these children are no longer wild!
There is an AIDS Center in Murmansk that monitors children from all over the Murmansk region. Here your child will be registered and undergo tests once every 3 months; all the center’s specialists are very friendly, always ready to help you and give advice. The center employs psychologists (t. 473299), an infectious disease specialist (t. 472499), a pediatrician (t. 473661), and a social worker.
If, according to clinical and laboratory data, the child needs special treatment, it will be prescribed in a timely manner and absolutely free of charge (for life!). Most often, children take medications 2 times a day, morning and evening. Medicines for children are most often in the form of syrups, provided that the therapy is successfully selected, children tolerate it well, side effects are rarely observed. Children are active, lead a very normal lifestyle, can play sports, etc. These are the most ordinary children.
Then, when the child reaches adolescence and realizes his diagnosis, there will be a very important point. The child must clearly understand how he differs from his peers. What he can and cannot do, unfortunately. What can he not do? He cannot be a blood or organ donor, and he must take a very responsible approach to choosing a partner to start a family. As for choosing a partner, HIV-infected people can create couples. Moreover, the child will be able to give birth to a healthy grandson or granddaughter. Many people do not understand that an HIV-infected woman can give birth to a healthy child. The risk of transmission of the virus with complete prevention may be less than 1%. A family can raise an HIV-infected son or daughter and receive healthy grandchildren.
For us, northerners, the issue of summer vacation is relevant. Your family is used to traveling to hot countries in the summer; won’t this be harmful for the HIV+ child? HIV-infected children can go to the sea in the summer, swim and relax peacefully. The only thing is that it is not recommended for them to deliberately lie in the open sun or purposefully sunbathe. Agree, active tanning is not recommended for all northern children. It is advisable to ask your child to wear a light T-shirt and a hat.
Does an HIV-infected child need a special diet? What can and cannot be eaten? In principle, you can eat anything, but there are small restrictions when taking medications (for example, you cannot drink grapefruit juice or infusions of certain medicinal herbs, as they can react with therapy and reduce its effectiveness).

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

If they receive therapy, such children will live long, create their own families and give birth to children. According to my observations, the absolute majority of HIV+ children are very beautiful, as if nature, due to their bright, extraordinary appearance, wants to give them an extra chance to find a family.

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

Constantly increasing all over the world. 90% of infection occurs naturally, i.e. .

Features of HIV infection in children

The following features of HIV infection in children have been clinically proven:

HIV in newborns can develop into AIDS by the age of five, which occurs in 80% of registered cases.
Children born with HIV in 20-30% of cases are affected by a rapidly progressing form of the disease, which gives a high viral load both immediately at birth and during the first months of life.

HIV disease progresses differently in children than in adults. This determines the features of treatment and care for children born with HIV. The physician caring for these young patients must have special knowledge and experience. HIV-positive children even endure the common childhood diseases chickenpox and measles with difficulty, with complications. Therefore, they definitely need vaccinations against rubella, mumps, and measles, which are not contraindicated for children with HIV. But they are contraindicated from vaccinations, which are represented by live vaccines: against tuberculosis (BCG), against yellow fever, against polio. It is possible that the polio vaccine can be replaced with an alternative that is not live.

Intellectually, children from HIV-infected parents develop normally, physically a little slower, and they begin puberty later.

HIV in newborns

In most cases, HIV in newborns is caused by the presence of the disease in the mother and is acquired:

in utero;
during childbirth;
when breastfeeding.

At the same time, HIV studies make it possible to identify a larger number of infected children in the 1st month of life and all HIV-positive children by the sixth month of life.

How often are HIV-infected children born? The probability (up to 50%) of having a sick child from an HIV-infected mother depends on whether the expectant mother is taking antiretroviral drugs, and how long and seriously she has been ill. On our website there is a detailed article about. If a child is infected with HIV during pregnancy or birth, HIV infection may develop more quickly. If they are not treated, the child will become seriously ill in early childhood.

How long do children with HIV live?

The question of how long children with HIV live worries many parents who are faced with this problem. The answer to this question is ambiguous. Despite the fact that the reaction of the nervous system of children to HIV is different from the reaction of adults, HIV infection in children transforms into the AIDS phase after approximately the same period of time as in them.

However, it is worth noting that due to the fact that children do not have developed immunity to various pathogenic microorganisms, they are at increased risk of developing opportunistic infections and, accordingly, they will more often require urgent Care doctor

Signs and symptoms of HIV in children

All children born with HIV contain maternal antibodies in their blood. It is possible to find out whether a child is sick using methods for diagnosing HIV infection in children at different periods of his life. Even if there are no signs of HIV in children, in order to confirm the diagnosis after receiving a positive answer, the test should be repeated.

How does HIV manifest in children? The main symptom is enlarged lymph nodes (

Pregnancy is wonderful moments, it is dreams and dreams, it is real happiness, especially if it is long-awaited. The expectant mother is making plans for how her life will change with the birth of her baby. And in the midst of all this, like a point-blank shot, the diagnosis of HIV can strike. The first feeling is panic. Life is falling apart, everything is going topsy-turvy, but you need to find the strength to stop and think carefully. Pregnancy and HIV are not a death sentence. In addition, you first need to confirm how reliable the diagnosis is.

Better late than even later

Indeed, for many women it is unclear why they need to constantly undergo tests for various infections during pregnancy. After all, they have a happy family, and this definitely cannot happen to them. In fact, pregnancy and HIV very often go hand in hand. It’s just that this disease is very insidious; it can be completely invisible for ten to twelve years. Even if there are a couple of lumps (lymph nodes) on the neck, this may go unnoticed. In some cases, the temperature may rise slightly, sore throat, vomiting and diarrhea may appear.

In order to identify the disease, special laboratory tests are needed. The program for the protection of motherhood and childhood necessarily includes careful consideration of the expectant mother. This is why pregnancy and HIV are two concepts that are often found together. Perhaps, if not for the interesting situation, the woman would never have consulted a doctor.

Diagnostics

As already said, the only one reliable way diagnostics are laboratory tests. When a woman registers for pregnancy, she is sent for tests from the first day. It should be noted that they cannot be prescribed forcibly, without the consent of the patient. But this is in your interests, because pregnancy and HIV, occurring simultaneously in the body, should not be left without the supervision of a doctor.

The most popular diagnostic method is ELISA, which detects antibodies to HIV in the patient’s blood serum. PCR allows you to detect the virus cells themselves in the blood. Typically, this examination is carried out when there is already a suspicion of HIV in order to accurately make a diagnosis.

If the doctor tells you such unpleasant news, you should not panic. HIV and pregnancy can coexist quite peacefully, and you may well give birth to a healthy baby. At the same time, we must not forget that it is vital for you to work closely with your doctor, take tests and follow recommendations.

Could there be an error?

Of course it can! This is why you should definitely undergo further examination, especially if you are confident in your partner. The fact is that primary diagnosis is carried out using the already designated ELISA method, which can give both false-positive and false-negative results. HIV and pregnancy at the same time is a blow for any expectant mother, but we must remember that the results obtained are not completely reliable.

A false negative result may occur if the infection occurred very recently. That is, a person is already a carrier, but the body has not yet had time to react and develop protection, antibodies, which doctors find. False-positive tests are even more common, especially in pregnant women. The reasons lie in the physiology of this difficult period. Of course, anyone will not be able to sleep when such news arrives, but first of all you need to weigh how possible such a development of events is, what were the prerequisites for this, and, of course, continue the examination.

Course of pregnancy

HIV and pregnancy can run their course without affecting each other too much. Pregnancy does not accelerate the progression of infection in women who are pregnant. early stage development of diseases. According to statistics, the number of pregnancy complications in this case in infected women practically does not exceed that in women without HIV. The only exception is that bacterial pneumonia is diagnosed somewhat more often.

An HIV test during pregnancy is also necessary to assess the stage of development of the disease. By the way, if we compare the mortality rate between those who gave birth and those who refused to do so (we are talking about termination of pregnancy after diagnosis), there are practically no differences.

However, as you already understand, the course of pregnancy very much depends on how long ago the disease has been developing, what stage it was at the time of conception, as well as on the condition of the body. The later the stage, the more complications may arise. These may include frequent and severe bleeding, anemia and premature birth, stillbirth, low fetal weight, and postpartum endometritis. Thus, the more severe the disease, the less chance of carrying and giving birth.

Clinical picture during pregnancy

This point is especially important for those women who learned about their disease already during pregnancy. How does HIV progress during pregnancy, what are the symptoms and treatment of this disease in expectant mothers? These are questions the answers to which could help many women evaluate what is happening to them and take adequate measures. But, unfortunately, it is difficult to describe them more or less accurately. The fact is that the immunodeficiency virus develops and progresses against the background of weakening protective functions body. And the more the immune system retreats under its onslaught, the more pronounced the symptoms will be.

Usually, 6-8 weeks after infection, a person begins to experience the first signs, which the expectant mother can easily mistake for a typical pregnancy picture. At this time, you may experience increased fatigue, fever and decreased performance, as well as diarrhea.

What is the main difficulty? This stage does not last long - just two weeks, and the symptoms subside. Now the disease is taking a latent form. The virus enters the persistence stage. The period can be very long, ranging from two to 10 years. Moreover, if we talk about women, then they have a tendency to have a long latent stage; in men it is shorter and does not exceed 5 years.

During this period, all lymph nodes enlarge. This is a suspicious symptom that requires examination. However, here lies the second difficulty: enlarged lymph nodes during pregnancy are normal and very common in healthy people. However, this symptom should definitely alert the expectant mother. It’s better to be on the safe side than to lose precious time.

Intrauterine development of the baby

In this matter, doctors were very interested in one point, namely, at what time the infection occurs. A lot of information for this was provided by tissues from spontaneous miscarriages and infected mothers. Thus, it was found that the virus is capable of causing intrauterine infection already in the first trimester, but the likelihood of this is not too high. In this case, children are born with the most severe lesions. As a rule, they do not live long.

More than half of all cases of infection occur in the third trimester, the period immediately before childbirth and the birth itself.

It is also interesting that until recently, the detection of antibodies to HIV in the blood of a pregnant woman was an indication for immediate termination of pregnancy. This is associated with a high risk of fetal infection. However, today the situation has changed. Thanks to modern treatment, a woman is not sent even for a planned caesarean section if she receives the necessary treatment.

The probability of infection of the baby

As we know, according to statistics, the immunodeficiency virus is transmitted from mother to child. This is one of three ways of infection. HIV positive during pregnancy increases the risk of having a child with a congenital disorder by 17-50%. However, antiviral treatment reduces the likelihood of perinatal transmission to 2%. However, when prescribing therapy, it is necessary to take into account the course of pregnancy. HIV, as we have already described, can also be different. Factors that increase the likelihood of passing it on to the fetus are:

late treatment when the disease has reached an advanced stage;
infection during pregnancy;
complicated pregnancy and difficult childbirth;
damage to the fetal skin during childbirth.

Infection during childbirth

In fact, if you test positive for HIV during pregnancy, you may well give birth to a healthy baby. But he will be born with his mother's antibodies. This means that immediately after birth the child will also be HIV positive. But for now this only means that his body does not have its own antibodies, but only maternal ones. It will take another 1-2 years until they completely disappear from the baby’s body, and now it will be possible to say for sure whether the child has become infected.

The expectant mother should know that HIV during pregnancy can be transmitted to the baby even during intrauterine development. However, the higher the mother’s immunity, the better the placenta works, that is, the organ that protects the fetus from viruses and bacteria in the maternal blood. If the placenta is inflamed or damaged, the likelihood of infection increases. This is another reason why it is necessary to undergo a thorough examination by your doctor.

But most often, infection occurs during childbirth. Therefore, pregnancy with HIV infection must be accompanied by mandatory antiviral therapy to reduce this likelihood to a minimum. The fact is that while passing through the birth canal, the baby has a high chance of coming into contact with blood, which dramatically increases the possibility of infection. If you remember from school, this is the shortest route of transmission of the virus. C-section recommended when a large number of viruses are detected in the blood.

After childbirth

As we have already said, an HIV test during pregnancy is necessary so that in case of a positive result, the mother can undergo full-fledged therapy and maintain her health. During pregnancy, physiological suppression of the immune system occurs. So while the previous study looked only at pregnancy, others have gone further and found that the development of HIV may accelerate after childbirth. Over the next two years, the disease may progress to a much more severe stage. Therefore, you cannot rely only on the desire to become a mother. Consultation with a doctor is required at the planning stage. Only this approach can become your assistant. HIV positive during pregnancy can seriously undermine health, which subsequently leads to a reduction in quality of life.

Breastfeeding and its dangers

The pregnancy of HIV-infected people can proceed very well when the baby develops normally and is born completely healthy. Of course, his blood will contain the mother’s antibodies, but they may not have an effect on the child’s immunity. However, now the mother faces a choice whether to feed her baby breast milk. The doctor must explain that breastfeeding almost doubles the risk of infection. So give it up, what will happen best choice. High-quality formulas will give the baby much better chances for the future.

Your risks

There are a number of factors that may not work in your favor. This is primarily a weakening of the mother's immunity. High, that is, a large number of viruses in a woman’s blood, is also bad sign. In this case, the doctor may suggest terminating the pregnancy. We have already talked about breastfeeding - 2/3 of all cases of infection of a child from his mother occur during the first six weeks of life. Multiple pregnancy- this is also a risk factor.

First of all, the expectant mother needs to register as early as possible. Be sure to follow all the recommendations of your doctor, then you will have a better chance of giving birth to a healthy baby. Starting from the 14th week, a pregnant woman can take antiviral drug"Azidothymidine" or its analogue. She receives such prevention completely free of charge. If a woman, for a number of reasons, did not take it before the 34th week, then she needs to start doing so at a later date. later. However, the earlier treatment is started, the less chance a mother has of passing the disease on to her baby.

Treatment

HIV therapy during pregnancy requires careful consideration of the mother's condition and the duration of pregnancy. That is why leave it to an experienced doctor and under no circumstances try to self-medicate. If you consulted a specialist before pregnancy, at the time of planning it, then most likely you will be prescribed combination therapy. The decision to start it is made on the basis of two tests - the level of CD-4 cells and the viral load. Current treatment requires the simultaneous use of two or more antiviral drugs.

An HIV test (pregnancy is a reason to cancel combination therapy) is the starting test on which all further treatment is based. Only one antiviral drug is left for the expectant mother to prevent infection of the baby.

If a woman took combination therapy before pregnancy, then if pregnancy occurs, she is recommended to take a break for the first trimester. In this case, blood for HIV during pregnancy is taken, as a rule, three times, and in a particular case the number of samples can be increased at the discretion of the doctor. The rest of the treatment is symptomatic. This allows you to reduce the risk of developmental defects in the unborn baby, as well as avoid the dangerous state of resistance, in which the virus is no longer treatable.

What a woman should remember

Despite the fact that the achievements of modern medicine make it possible to reduce the risk of infection of a child from his own mother to 2%, it still exists. Therefore, you need to weigh the pros and cons, because a woman, even if she is HIV-infected, wants to carry and give birth to a healthy baby. The difficulty is that you will not know for a long time whether your baby was born HIV-positive, and this cannot be predicted in advance. So you have a long and tedious wait ahead of you. The ELISA will give a positive result approximately 6 months after birth, so be patient.

When deciding to give birth, a woman should know what awaits her child if he falls into this unlucky 2%. We remind you that such a minimal probability of giving birth to a baby with the immunodeficiency virus is only possible if the woman did not follow all the doctors’ recommendations, did not undergo constant examinations and did not take medications exactly according to the regimen.

HIV is most severe in those babies who are infected in utero. The symptoms in this case are much more pronounced, and often such children do not live to see one year old. Fewer manage to experience adolescence, but it is possible to predict their life in mature age This is only possible hypothetically, since so far there have been no such cases.

Infection with HIV during childbirth or breastfeeding It proceeds somewhat easier, because the virus falls on an already formed organism with a developing immune system. However, the child's life expectancy will be very limited. Usually doctors do not make a prognosis longer than 20 years.

Prevention

Congenital HIV infection means hospitals and medications from childhood. Of course, everything must be done to prevent such developments. Therefore, it is very important to carry out timely prevention of this disease. Today this work is carried out in three directions. First of all, this is HIV prevention among women of childbearing age. The second direction is prevention unwanted pregnancies among women with HIV. Finally, the last thing is the prevention of transmission of infection from a woman to her child.

Testing positive for HIV during pregnancy is not the end of the world. However, a woman must be aware that she has a chance to infect her baby. Modern therapy has greatly increased the life expectancy of an HIV-positive person. Many live 20 years or more after infection. However, if for an adult this is a whole life, then for a child it is a chance to meet youth and leave. Medical achievements do not relieve women of responsibility, so first of all, each of them should think about the future of their baby.

Instead of a conclusion

This is a topic that you can talk about endlessly, and there will still be a lot of unsaid. An HIV diagnosis is like a bad dream, ruining all plans for the future, but it is especially tragic to learn about your diagnosis during pregnancy. In this case, before expectant mother There is a difficult choice and colossal responsibility. Give up your baby or give birth? Will he be healthy or will he face endless treatment? All these questions do not have a clear answer. Today we gave you a brief tour and talked about the main problems associated with pregnancy in infected women.

Of course, the achievements of modern medicine have made it possible for a huge number of women to experience this. Today, people diagnosed with HIV believe that they are full members of society, have the right to a family and the birth of healthy children.

Humanity is familiar with HIV infection for more than 30 years. During this time, people with a positive status went from being rare individuals to becoming a noticeable part of the population.

And for them, infection is simply a special way of life in which certain rules must be followed.

Due to the nature of the infection, it turned out that the majority of carriers of the virus are young boys and girls who dream of love, family, and children. HIV does not make this impossible, you just need to know how to protect yourself and prevent the infection from passing from mother to baby.

The risk of infecting a child with HIV in pregnant women

If you rely on luck and do not take any preventive measures, almost half of the children will be born with the virus - 40-45%. If all necessary measures are taken, artificial feeding, this figure can be reduced to 6-8%, and according to some data, to 2%.

More than half of babies become infected during childbirth, approximately 20% each during different periods of pregnancy (especially in the second half) and during breastfeeding.

Planning pregnancy with HIV

The good old truth that connects the health of mother and child is also true here. If a woman knows about her status and wants to get pregnant, she definitely needs to determine the viral load in the blood and find out the number of CD4 cells.

When not very good results tests (high levels of viruses and insufficient levels of lymphocytes) will first have to be improved. This will make pregnancy easier, and the risk of HIV transmission will be noticeably lower.

Eg, with CD4 less than 200 the likelihood of the baby becoming infected will be 2 times greater, and the viral load more than 50,000 is considered 4 times more dangerous.

Evaluated approximate regimen for taking antiretroviral drugs during future pregnancy:

if the woman’s condition and laboratory data did not require medications before, it is better to do without them for the first three months after conception;
If treatment has been started previously, it is not advisable to interrupt it. Firstly, a sharply increasing number of viruses can lead to transmission to the child. In addition, there is a potential for opportunistic infections and drug resistance;
if the treatment regimen included efavirenz, they try to replace it with other drugs due to the pathological effect on fetal development;
It is not recommended to prescribe stavudine and didanosine; this regimen is not easily tolerated by pregnant women; serious problems with liver.

Conception during HIV infection

Since with a positive status, sexual intercourse must be protected (with a condom), pregnancy can be problematic.

It's a little easier if both partners live with the virus, but even here there is a risk of exchanging different strains, including drug-resistant ones. In addition, it is believed that this increases the likelihood of transmitting the infection to the child. If there is only HIV in the family one, then we must try not to infect it.

It’s easier to protect an uninfected man– it is enough to collect his sperm in a sterile vessel and carry out self-fertilization using a special kit.

It is more difficult if the virus is detected only in a man. The concentration of HIV in semen is usually very high, so danger to the woman is very likely.

There are several possible solutions:

reduce the viral load in men to a minimum and select the period of ovulation in women. Unfortunately, this cannot completely protect a woman. And infection during conception is also dangerous for the baby, because in the first few months of infection the number of viruses in the blood is maximum;
carry out a special manipulation to cleanse the partner’s sperm, separating sperm from seminal fluid (the location of viruses). The resulting material is then injected into the woman.
. The method is quite complex, expensive and not available to all couples. Isolated individual sperm are combined in a test tube with eggs obtained from a woman, then the embryos are early stages developments are inserted directly into the uterus;
use of donor sperm from special banks. But some men categorically refuse this opportunity, and for women it can be important to give birth to the child of their loved one.

HIV infection and pregnancy - the basic principles of having a healthy child

Antiretroviral therapy after three months pregnancy. The safest drug is zidovuddin, often used in combination with nevirapine.

Observation by doctors, adequate nutrition, prevention. A premature baby (especially with a term of less than 1 month) is not able to resist the virus and is easily infected.

Treatment and prevention opportunistic diseases in the mother.

Planning the type of birth. Since most babies become infected during childbirth, going to term can reduce this likelihood. But if such an operation is forced to be resorted to due to problems that have arisen, the risk may be even higher.

If it is possible to reduce the concentration of viruses to less than 1000 in 1 μl, normal childbirth also becomes quite safe. You should avoid opening the membranes of the membranes and various obstetric manipulations.

Refusal to breastfeed. Prophylactic appointment antiretroviral drugs for newborns in syrups.

It is impossible to immediately determine whether a child is infected or not. All tests for HIV can be positive for up to one and a half years of life, because maternal antibodies are in his blood and are gradually destroyed. If after this period the result does not change, then it is infected.

More exact method— detection of the virus in the blood using PCR (polymerase chain reaction). At 3, 6 and 12 months, the reliability of this type of diagnosis is 90-99%.

A slowly progressive infectious disease caused by retroviruses that attack the immune and central nervous system, with the development of an immunodeficiency state leading to the death of the patient from opportunistic infections and tumors - this is HIV infection (infection caused by the human immunodeficiency virus). From this article you will learn about what kind of children are born from HIV-infected mothers.

HIV carriers

There are three groups:

HIV-infected people without clinical manifestations;
HIV-infected people with nonspecific manifestations;
patients with clinical manifestations of AIDS.

First group: regimen and nutrition according to age, physical exercise no limits. Examination once every 3 months, once a year - in a specialized hospital with a full clinical and laboratory examination to decide on preventive therapy.

Second group: gentle regime with additional daytime rest; Schoolchildren are allowed to study at home. Meals 4 times a day. Examination once a month, clinical and immunological examination - 2 times a year in a hospital setting.

Third group: children are observed in an infectious diseases clinic until recovery or stable remission after opportunistic infections. In the future, home inspections 2 times a month. The motor mode is determined by the state of physical development and the presence of concomitant diseases.

Birth of a child to a mother with HIV

Children born to HIV-infected mothers should be under medical supervision. Monitoring of children with perinatal contact is carried out by a pediatrician at the City Center for the Prevention and Control of AIDS. Recommended timing of the examination according to the Order of the Committee on Health and the Center for State Sanitary and Epidemiological Surveillance in St. Petersburg No. 29-r/4 dated 02/04/2002: at birth, at 1 month, 3, 6, 9, 12, 18, 24 months. If clinical and laboratory signs of HIV are detected at the age of 12 months, an additional examination is carried out at the age of 15 months.

At the specified time, the physical and psychomotor development of the child is assessed, blood tests are examined (clinical and biochemical, immunological - CD4, CD8, CD4/CD8), urine tests, and diseases associated with HIV infection are recorded. Serological blood testing is periodically repeated using ELISA for markers of hepatitis B and C, HSV, CMV, toxoplasmosis; perform a cytological examination of saliva and urine for CMV. The content of immunoglobulins and proteinogram parameters are determined once every 6 months.

Prevention

Specific prevention for children born to HIV-infected mothers and patients with HIV infection is carried out with killed and recombinant vaccines. If children do not have clinical manifestations of HIV, tuberculosis is prevented with the BCG-M vaccine from 6 months of age. The recombinant vaccine against hepatitis B can be used from the first hours of life according to the scheme 0 – 1 – 2 – 12. Poliomyelitis is prevented within the prescribed period, but only with killed vaccines (Tetracok, Imovax Polio). DTP vaccines (ADS or ADS-M) are administered to HIV-infected people, including those with clinical manifestations, according to the standard regimen, however, in case of severe immunosuppression, it is recommended to monitor the titers of anti-diphtheria antibodies 1-2 months after the course of immunization and, if necessary, additional administration of DPT -M – toxoid.

What to do if an HIV-infected child is born?

Live vaccines against measles, rubella and mumps (single-drug and associated) can be administered to children after a diagnosis of HIV infection has been established in accordance with the vaccination schedule only in the absence of clinical manifestations of the disease. Additionally, HIV-infected children are also recommended the administration of killed influenza vaccines, polysaccharide vaccines against meningococcal and pneumococcal infections, as well as vaccines against hepatitis A and Haemophilus influenzae.

Azidothymidine (AZT) is used to prevent perinatal infection: starting from the 14th week of pregnancy until delivery, women receive AZT orally 100 mg 5 times a day. In the 1st stage of labor, the drug is prescribed intravenously during the first hour at a dose of 2 mg/kg, then the infusion continues until the expulsion period at a dose of 1 mg/kg per hour. For a newborn from 8-12 hours of life, AZT is given orally in the form of syrup every 6 hours at a dose of 2 mg/kg or intravenously at a dose of 1.5 mg/kg. Treatment continues for 6 weeks.

For emergency prevention of perinatal HIV infection, a single oral administration of nevirapine to the mother at the beginning of labor at a dose of 200 mg, to the newborn during the first 72 hours of life at a dose of 2 mg/kg. Children of HIV-infected mothers should not receive breast milk, to prevent infection of the newborn.