Children from HIV-infected people: are there any chances of having a healthy child? The impact of HIV infection on pregnancy. Is there a chance to give birth to a healthy child?

Today in our country the topic of HIV infection is acute. Many women may not be aware of their positive status before pregnancy. Some women infected with HIV want to have children, but are afraid of infecting a new person with the virus. The riskiest period when a mother can transmit the virus to her child is the third trimester of pregnancy and the birth process. However, today's medical advances make it possible to conceive and give birth to a healthy baby, even with an infection. HIV and pregnancy are compatible.

HIV and pregnancy: how to give birth to a healthy baby

Women infected with HIV can have children, just like healthy women. If a woman knows about infection, she first needs to contact an AIDS organization, which will diagnose and do everything possible so that the woman can give birth to a healthy person. If a woman does not take any measures, the likelihood of infection of the child is very high.

If a woman with advanced AIDS decides to give birth to a child, the likelihood of infection of the fetus is very high, since there is a high concentration of the virus in the blood, and the woman’s immunity is greatly weakened.

If a woman finds out that she is HIV-infected, first of all she should contact the center, where specialists will first reassure her, tell her more about her condition, conduct research, and talk about precautions. If a woman knows about her HIV status, she must first go to an appointment with a gynecologist, who will determine the timing of pregnancy and its course. Then the pregnant woman should see an infectious disease specialist.

How to avoid infecting your child:

• The woman must take special medications.
• During childbirth, a woman is given a drug that will reduce the risk of infection of the baby.
• A newborn baby is given antiretroviral drugs.

The newborn is given special medications to remove remnants of the virus from the bloodstream. It is important that the drug is given to the child no later than three days after birth. All women infected with HIV should remember that they should not breastfeed, as the virus is transmitted through breast milk.

The problem of women in labor: pregnancy and HIV infection

Many women who find out they are HIV positive do not give up the opportunity to have a child. Modern medicine allows a woman to give birth to an absolutely healthy person. Women must take responsibility for the decision to have a child.

Before conceiving, they must undergo a thorough examination to determine the risk of infection of the child.

The issue of continuing treatment for the woman herself during pregnancy is discussed individually with the attending physician. It will be better if the treatment continues. If treatment is suspended, there is a high probability that the viral load will increase, which will lead to an abnormal course of pregnancy.

What problems can a woman encounter:

• The problem of getting pregnant from an HIV-negative man. When performing sexual intercourse, although not great, there is a risk of infection for a man. Therefore, it is better if a woman inseminates herself artificially.
• Pregnancy from an HIV-positive man to an HIV-negative woman. Sperm cannot influence the infection of the fetus, but during sexual intercourse there is a possibility of infecting the partner, which can lead to infection of the child.

Many women use the method of artificial insemination, which prevents the risk of infection of the fetus. To decide whether to have a child, a woman needs to undergo a serious examination and weigh the pros and cons. Women carrying a child should be aware of possible complications during pregnancy.

Where do HIV-infected people give birth?

Just a few years ago, women giving birth with HIV-positive status could die of AIDS without ever experiencing motherhood. Many women refuse to give birth to a child, fearing the condemnation of society. But today medicine has stepped far forward, providing the opportunity for HIV-infected mothers to give birth to healthy children.

First of all, an HIV-infected woman must be prescribed correct and effective treatment.

In order for the prescription to be correct, it is necessary to determine the immune status of the viral load. HIV-infected people should closely monitor their condition and get tested regularly. Women in labor can be observed in special HIV centers, but every woman has the right to give birth in any maternity hospital.

Precautions during childbirth:

• HIV-infected women give birth in specially designated wards.
• Doctors use special instruments and materials, which are burned after the operation.

Women in labor also burn their bed linen. After birth, the baby is examined. Today, there are methods that make it possible to determine a child’s HIV status at a very early age.

Symptoms of HIV during pregnancy

All pregnant women, after they are registered, are tested for HIV infection. HIV is dangerous because signs of infection can be completely invisible. Infection of a child from a man cannot occur, since the fetus is infected from the mother.

Before getting pregnant, it is better to take an HIV test - this will help avoid many problems.

Having a child by an HIV-positive woman does not mean that her child will be infected. Typically, people infected with HIV show no symptoms. That is why it is better if the conception of a child occurs after the woman has passed the test.

Symptoms of HIV during pregnancy:

• interrupted pregnancy;
• reduced immunity;
• frequent chronic diseases.

The child is at risk of contracting HIV at an early and late stage. Understanding fathers and mothers of their status can save the child from infection. Timely therapy saves women and their children.

Is it compatible: HIV and pregnancy (video)

The birth of a healthy child from HIV-infected parents is possible. Modern medicine helps a woman conceive and give birth to a healthy baby. Doctors pay special attention to the woman’s therapy, as well as the third trimester of pregnancy and the birth process itself. It is during childbirth that the chances of infection increase significantly. Nowadays, every woman can get a free HIV test. It is better to do this before conceiving a child.

• Which doctors should you contact if you have HIV infection during pregnancy?

What is HIV infection in pregnant women

In recent years, the number of women of childbearing age among those infected with HIV has increased significantly. HIV infection in a pregnant woman invariably presents significant difficulties for the obstetrician. Doctors are faced with the task of reducing the risk of transplacental transmission of the virus to the fetus and maintaining the health of the expectant mother. Pregnancy management should be carried out by an obstetrician and an infectious disease virologist.

What causes HIV infection in pregnant women?

AIDS is a disease associated with severe impairment of T-cell immunity in adults and T- and B-cell immunity in children. The causative agent of AIDS is AIDS virus(HIV) is an RNA virus. There are two types of HIV - HIV-1 and HIV-2. Of these, HIV-1 is the most common. It has been proven that HIV-2 infection occurs less frequently, its incubation period is longer, and it is less virulent than HIV-1. With HIV-2 infection, the disease develops in 4-10% of infected people, with HIV-1 infection - in 20-40%.

A special feature of the virus is the ability to synthesize, based on the RNA itself, the DNA necessary for the virus to reproduce using the enzyme reverse transcriptase (revertase). The virus has a tropism for lymphoid cells - T-helper cells (CD4), macrophages, monocytes and neurons, in which it is able to integrate into chromosomal DNA, persist for a long time, disrupt their function and cause a restructuring of the immune system. Viral replication begins after immune stimulation of T lymphocytes due to reinfection or under the influence of other acute and chronic diseases. Rapid reproduction causes the death of CO4 cells. In this case, functional failure of T-cell immunity occurs, which causes a violation of the antigen-specific differentiation of B-lymphocytes and their polyclonal activation. This manifests itself in an increase in the concentration of immunoglobulins in the peripheral blood, and the resulting dysfunction of B-lymphocytes with the development of their functional failure causes a disruption in the synthesis of specific antiviral antibodies. After multiplication in the cells of the immune system, HIV spreads hematogenously throughout the body and can be isolated from any environment in the body. It is capable of maintaining its viability for a long time in blood plasma devoid of cellular elements, which explains the high probability of its transmission through a syringe.

HIV is heterogeneous, has a high degree of genetic variability, quickly dies when boiled or exposed to disinfectants, but is resistant to ionizing radiation and ultraviolet radiation.

The source of infection is AIDS patients and virus carriers. Moreover, the period of virus carriage can be very long (years), and during the first years after infection the carrier may be seronegative due to the lack of virus replication. Routes of transmission of infection are sexual (75% of infected), transfusion (through infected blood products, drug addicts), transplacental, intranatal, postnatal (through infected milk and through close household contacts between mother and newborn).

HIV has been isolated from many body fluids, including urine, saliva and tears, but so far only cases of infection through blood, semen, vaginal secretions and breast milk have been described. “Wet kisses” can pose some danger. The risk of sexually transmitted HIV infection increases with the presence of other STIs.

Symptoms of HIV infection in pregnant women

The incubation period of AIDS ranges from several months to 5 years or more. Transmission of HIV does not necessarily lead to the development of the disease. In 60-70% of infected people, the infection remains asymptomatic for a number of years. 2-8% of infected people develop clinical signs of AIDS each year. In this case, the disease has 6 stages: the incubation period, the acute stage of the disease, the latent period, persistent generalized lymphadenopathy, AIDS - an associated symptom complex and AIDS itself. On average, the time it takes for AIDS to develop from the moment of infection is 10 years; the disease can debut at any stage, including AIDS, and can stop at any stage without reaching AIDS.

Diagnosis of HIV infection in pregnant women

It is carried out based on the identification of risk factors or clinical symptoms with confirmation of the diagnosis using serological tests. PCR to detect the viral genome in lymphocytes is not yet used as a standard diagnostic test. Serological studies are carried out using enzyme-linked immunosorbent assays in combination with confirmatory tests. More specific tests include determination of HIV proviral DNA, viral load and number of helper cells, and T-cell function.

In children, serodiagnosis is difficult due to frequent false-positive results due to transplacental transfer of maternal antibodies.

Treatment of HIV infection in pregnant women

Pregnancy and childbirth in HIV-infected people. The course of HIV infection may accelerate and worsen during pregnancy due to the immunosuppression inherent in the gestational process. The course of pregnancy is also often complicated. Noteworthy is the high incidence of cervical intrapartum neoplasia, symptomatic candidiasis, and increased incidence of preterm birth.

The most dangerous complication of pregnancy is perinatal infection of the fetus with HIV infection, which without appropriate therapy is observed in 30-60% of cases, regardless of the presence of symptoms of the disease in the mother. Vertical transmission of HIV can occur during pregnancy, childbirth and postnatally. HIV can be transmitted either as a cell-bound virus or as a free virus. HIV-infected cells of the placenta also act as a source of infection. In this case, there are 3 possible ways of transferring the virus to the fetus.

Transplacental transfer of free virions as a result of various damage to the fetoplacental barrier (placental abruption, placentitis, FPN) with subsequent interaction of the virus with fetal CO4 lymphocytes.

• Primary infection of the placenta and accumulation of the virus in Hofbauer cells, followed by virus reproduction and its transfer to the fetus.
• Intrapartum infection of the fetus due to contact of the mucous membranes of the fetus with infected blood or secretions of the birth canal.
• Postnatally, 15 to 45% of children from HIV-infected mothers are infected. Most of these women are unaware of the infection and mainly infect their children through breastfeeding.

Maternal risk factors for vertical transmission: large viral load in the body with a high level of virus in the plasma, identification of a virulent HIV isolate, low number of T-helper cells.

Autopsy of tissues from spontaneous miscarriages in HIV-positive mothers reveals that HIV can cause intrauterine infection already in the first trimester. More than half of all cases of vertical transmission of infection occur immediately before or during childbirth, and antenatal infection in most cases occurs in the third trimester.

HIV infection of the fetus or a newborn leads to the development of immunodeficiency, which differs from that in adults. Before 5 years of age, AIDS develops in 80% of children infected with HIV perinatally. The first signs of intrauterine HIV infection are malnutrition (in 75% of cases) and various neurological symptoms (in 50-70% of cases). Soon after birth, persistent diarrhea, lymphadenopathy (90%), hepatosplenomegaly (85%), oral candidiasis (50%), and developmental delay (60%) occur. Chronic pneumonia and recurrent infections are common. Symptoms of central nervous system damage are associated with diffuse encephalopathy, cerebellar atrophy, microcephaly, and deposition of intracranial calcifications.

There are early and late HIV infections. Approximately 20-30% of children infected vertically may have an early onset severe form of the disease - a rapidly progressive form. These patients have a high viral load at birth and in the first months of life, and already in infancy they experience a rapid loss of helper T lymphocytes.

In 70-75% of children infected vertically, a slowly progressive form of infection is observed: low viral load at birth, a stable number of helpers for a long time, absence of clinical manifestations or the presence of only mild symptoms (lymphadenopathy, mumps), as well as recurrent bacterial infections. The proportion of children with a slowly progressive form of the disease that reaches the AIDS stage is approximately 5-10% per year. In 5% of children, clinical and immunological symptoms do not progress. This is associated with genetic factors, preservation of immunocompetence and persistence of low-virulent HIV isolates.

The causes of death in young children with AIDS are generalized CMV infection or sepsis caused by gram-negative or opportunistic bacteria; in older children, as in adults, it is a combination of pneumocystis with Kaposi's sarcoma.

More recently, the detection of antibodies to HIV in the blood of a pregnant woman was an indication for termination of pregnancy due to the high risk of perinatal infection. However, at present, the administration of specific antiviral drugs to pregnant women can reduce the risk of intrauterine infection to 5-10%. Such an antiviral drug for pregnant women is zidovudine, an analogue of HIV nucleosides. It is prescribed in doses from 300 to 1200 mg/day. No evidence of a teratogenic effect of zidovudine has been established. Opportunistic infections are treated in the same way as in non-pregnant women.

Maternal HIV infection is not an indication for cesarean section in women receiving antiviral drugs, since the risk of fetal infection during cesarean section and vaginal birth is approximately the same. In HIV-infected women who have not received treatment during pregnancy, abdominal delivery is currently the method of choice.

In the case of vaginal delivery, one should adhere to the rules for managing childbirth during any viral infections: reduce the duration of the anhydrous interval and avoid the use of any obstetric manipulations that injure the skin of the fetus. To prevent infection at the time of delivery, zidovudine is taken in capsules. To prevent postnatal infection, breastfeeding during HIV infection is contraindicated.

It is believed that if the following set of recommendations is followed, the risk of infection of a child does not exceed 3%:

• antiretroviral therapy prescribed to the mother during the second half of pregnancy, to the newborn - during the first 6 weeks of life;
• planned caesarean section;
• refusal of breastfeeding.

Prevention of HIV infection in pregnant women

Specific prevention, unfortunately, has not yet been developed. In order to reduce the incidence of perinatal infection, the Russian Federation has adopted mandatory screening of all pregnant women for HIV infection three times during pregnancy: upon registration, at 24-28 weeks, and before childbirth. HIV screening of pregnant patients' sexual partners is also recommended. If at least one of the partners is diagnosed with HIV infection, they should independently decide on the advisability of prolonging such a pregnancy, knowing the degree of risk of infection of the fetus. Due to the widespread prevalence of HIV infection and the risk of infection through breast milk, milk donation is prohibited in many countries.

Thus, when preventing vertical transmission of HIV infection, the following is used.

• Obstetric activities:
  • HIV testing;
  • exclusion of invasive prenatal diagnosis in pregnant women with HIV;
  • planned caesarean section before the onset of labor;
  • during natural childbirth:
    • excluding early amniotomy,
    • disinfection of the birth canal,
    • prevention of cuts and ruptures of the perineum.
• Therapeutic measures:
  • treatment of pregnant women and newborns with zidovudine.
• Pediatric activities:
  • adequate primary treatment in the maternity ward;
  • refusal to breastfeed.

Statistics indicate an annual increase in the number of HIV-infected people. The virus, which is very unstable in the external environment, is easily transmitted from person to person during sexual intercourse, as well as during childbirth from mother to child and during breastfeeding. The disease is controllable, but complete cure is impossible. Therefore, pregnancy with HIV infection should be under medical supervision and with appropriate treatment.

About the pathogen

The disease is caused by the human immunodeficiency virus, which is represented by two types - HIV-1 and HIV-2, and many subtypes. It affects cells of the immune system - CD4 T lymphocytes, as well as macrophages, monocytes and neurons.

The pathogen multiplies quickly and within 24 hours infects a large number of cells, causing their death. To compensate for the loss of immunity, B lymphocytes are activated. But this gradually leads to the depletion of protective forces. Therefore, in HIV-infected people, opportunistic flora is activated, and any infection occurs atypically and with complications.

The high variability of the pathogen and the ability to lead to the death of T-lymphocytes makes it possible to evade the immune response. HIV quickly develops resistance to chemotherapy drugs, so at this stage of medical development it is not possible to create a cure against it.

What signs indicate illness?

The course of HIV infection can last from several years to decades. Symptoms of HIV during pregnancy do not differ from those in the general population of infected people. Manifestations depend on the stage of the disease.

At the incubation stage, the disease does not manifest itself. The duration of this period varies - from 5 days to 3 months. Some people experience early HIV symptoms after 2-3 weeks:

• weakness;
• flu-like syndrome;
• enlarged lymph nodes;
• slight causeless increase in temperature;
• rash on the body;

After 1-2 weeks, these symptoms subside. The period of calm can last a long time. For some it takes years. The only signs may be periodic headaches and constantly enlarged, painless lymph nodes. Skin diseases such as psoriasis and eczema may also occur.

Without treatment, after 4-8 years the first manifestations of AIDS begin. In this case, the skin and mucous membranes are affected by bacterial and viral infections. Patients lose weight, the disease is accompanied by candidiasis of the vagina, esophagus, and pneumonia often occurs. Without antiretroviral therapy, after 2 years the final stage of AIDS develops, and the patient dies from an opportunistic infection.

Management of pregnant women

In recent years, the number of pregnant women with HIV infection has been increasing. This disease can be diagnosed long before pregnancy or during the gestational period.

HIV can pass from mother to child during pregnancy, during childbirth, or through breast milk. Therefore, planning pregnancy with HIV should be done together with a doctor. But not in all cases the virus is transmitted to the child. The following factors influence the risk of infection:

• maternal immune status (number of viral copies more than 10,000, CD4 - less than 600 in 1 ml of blood, CD4/CD8 ratio less than 1.5);
• clinical situation: the woman has an STI, bad habits, drug addiction, severe pathologies;
• virus genotype and phenotype;
• condition of the placenta, the presence of inflammation in it;
• gestational age during infection;
• obstetric factors: invasive interventions, duration and complications of childbirth, water-free interval;
• the condition of the newborn’s skin, the maturity of the immune system and digestive tract.

The consequences for the fetus depend on the use of antiretroviral therapy. In developed countries, where women with infection are monitored and follow instructions, the effect on pregnancy is not apparent. In developing countries, the following conditions may develop with HIV:

• spontaneous miscarriages;
• antenatal fetal death;
• accession of STIs;
• premature;
• low birth weight;
• infections of the postpartum period.

Examinations during pregnancy

All women donate blood for HIV upon registration. A repeat study is carried out at 30 weeks, a deviation up or down by 2 weeks is allowed. This approach makes it possible to identify at an early stage pregnant women who are already registered as infected. If a woman becomes infected on the eve of pregnancy, then the examination before childbirth coincides with the end of the seronegative period, when it is impossible to detect the virus.

A positive HIV test during pregnancy provides grounds for referral to an AIDS center for further diagnosis. But a rapid HIV test alone does not establish a diagnosis; this requires an in-depth examination.

Sometimes an HIV test during gestation turns out to be false positive. This situation can frighten the expectant mother. But in some cases, the peculiarities of the functioning of the immune system during gestation lead to changes in the blood that are defined as false positive. Moreover, this may apply not only to HIV, but also to other infections. In such cases, additional tests are also prescribed that allow an accurate diagnosis to be made.

The situation is much worse when a false negative analysis is obtained. This can occur when blood is drawn during the period of seroconversion. This is the period of time when infection has occurred, but antibodies to the virus have not yet appeared in the blood. It lasts from several weeks to 3 months, depending on the initial state of immunity.

A pregnant woman who tests positive for HIV and further testing confirms the infection is offered termination of pregnancy within the time limits established by law. If she decides to keep the child, then further management is carried out simultaneously with specialists from the AIDS Center. The need for antiretroviral (ARV) therapy or prophylaxis is decided, and the timing and method of delivery is determined.

Plan for women with HIV

For those who were registered as already infected, as well as with a detected infection, in order to successfully bear a child, it is necessary to adhere to the following observation plan:

1. When registering, in addition to basic routine examinations, an ELISA test for HIV and an immune blotting reaction are required. The viral load and the number of CD lymphocytes are determined. A specialist from the AIDS Center gives advice.
2. At 26 weeks, the viral load and CD4 lymphocytes are re-determined, and a general and biochemical blood test is taken.
3. At 28 weeks, the pregnant woman is consulted by a specialist from the AIDS Center and selects the necessary AVR therapy.
4. At 32 and 36 weeks, the examination is repeated; a specialist from the AIDS Center also advises the patient on the results of the examination. At the last consultation, the timing and method of delivery are determined. If there are no direct indications, then preference is given to urgent childbirth through the birth canal.

Throughout pregnancy, procedures and manipulations that lead to disruption of the integrity of the skin and mucous membranes should be avoided. This applies to conducting and. Such manipulations can lead to contact of the mother's blood with the baby's blood and to infection.

When is urgent analysis needed?

In some cases, a rapid HIV test may be prescribed in the maternity hospital. This is necessary when:

• the patient was not examined even once during pregnancy;
• only one test was taken during registration, and there was no repeat test at 30 weeks (for example, a woman is admitted with a threat of premature birth at 28-30 weeks);
• The pregnant woman was tested for HIV at the right time, but her risk of infection is increased.

Features of HIV therapy. How to give birth to a healthy baby?

The risk of transmitting the pathogen vertically during childbirth is up to 50-70%, and during breastfeeding – up to 15%. But these indicators are significantly reduced from the use of chemotherapy drugs and when breastfeeding is stopped. With a correctly selected regimen, a child can get sick only in 1-2% of cases.

Drugs for ARV therapy for prophylactic purposes are prescribed to all pregnant women, regardless of clinical symptoms, viral load and CD4 count.

Preventing transmission of the virus to a child

Pregnancy in HIV-infected people takes place under the guise of special chemotherapy drugs. To prevent a child from becoming infected, the following approaches are used:

• prescribing treatment for women who were infected before pregnancy and are planning to conceive;
• use of chemotherapy for all infected;
• ARV therapy drugs are used during childbirth;
• After childbirth, similar medications are prescribed for the child.

If a woman becomes pregnant from an HIV-infected man, then ARV therapy is prescribed to the sexual partner and to her, regardless of the results of her tests. Treatment is carried out during pregnancy and after birth.

Particular attention is paid to those pregnant women who use drugs and have contact with sexual partners with similar habits.

Treatment upon initial detection of the disease

If HIV is detected during gestation, treatment is prescribed depending on the period when this occurred:

1. Less than 13 weeks. ARV drugs are prescribed if there are indications for such treatment before the end of the first trimester. For those who have a high risk of fetal infection (with a viral load of more than 100,000 copies/ml), treatment is prescribed immediately after testing. In other cases, in order to exclude a negative effect on the developing fetus, the start of therapy is delayed until the end of the 1st trimester.
2. Duration from 13 to 28 weeks. If the disease is detected in the second trimester or an infected woman applies only in this period, treatment is prescribed urgently immediately after receiving the results of tests for viral load and CD
3. After 28 weeks. Therapy is prescribed immediately. A regimen of three antiviral drugs is used. If treatment is first started after 32 weeks and the viral load is high, a fourth drug may be added to the regimen.

A highly active antiviral therapy regimen includes certain groups of drugs that are used in a strict combination of three of them:

• two nucleoside reverse transcriptase inhibitors;
• protease inhibitor;
• or a non-nucleoside reverse transcriptase inhibitor;
• or an integrase inhibitor.

Drugs for the treatment of pregnant women are selected only from groups whose safety for the fetus has been confirmed by clinical studies. If it is impossible to use such a regimen, you can take medications from available groups, if such treatment is justified.

Therapy in patients who have previously received antiviral drugs

If HIV infection was detected long before conception and the expectant mother received appropriate treatment, then HIV therapy is not interrupted even in the first trimester of gestation. Otherwise, this leads to a sharp increase in the viral load, deterioration of test results and the risk of infection of the child during pregnancy.

If the regimen used before gestation is effective, there is no need to change it. The exception is drugs with a proven danger to the fetus. In this case, the drug is replaced on an individual basis. Efavirenz is considered the most dangerous of these for the fetus.

Antiviral treatment is not a contraindication for planning pregnancy. It has been proven that if a woman with HIV consciously approaches conceiving a child and follows the medication regimen, then the chances of giving birth to a healthy baby increase significantly.

Prevention during childbirth

The protocols of the Ministry of Health and WHO recommendations define cases when it is necessary to prescribe Azidotimidine solution (Retrovir) intravenously:

1. If antiviral treatment was not used when the viral load before delivery was less than 1000 copies/ml or more than this amount.
2. If a rapid HIV test in the maternity hospital gives a positive result.
3. If there are epidemiological indications, contact with a sexual partner infected with HIV during the last 12 weeks while using injecting drugs.

Choosing a method of delivery

To reduce the risk of infection of the child during childbirth, the method of delivery is determined on an individual basis. Childbirth can be carried out through the birth canal if the woman in labor received ART during pregnancy and the viral load at the time of birth is less than 1000 copies/ml.

The time of rupture of amniotic fluid must be recorded. Normally, this occurs in the first stage of labor, but sometimes prenatal effusion is possible. Considering the normal duration of labor, this situation will result in an anhydrous interval of more than 4 hours. This is unacceptable for an HIV-infected woman in labor. With such a duration of the water-free period, the likelihood of infection of the child increases significantly. A long period without water is especially dangerous for women who have not received ART. Therefore, a decision may be made to terminate labor by.

During childbirth with a living child, any manipulations that violate the integrity of tissues are prohibited:

• amniotomy;
• episiotomy;
• vacuum extraction;
• application of obstetric forceps.

Labor induction and labor intensification are also not performed. All this significantly increases the child’s chances of infection. It is possible to carry out the listed procedures only for health reasons.

HIV infection is not an absolute indication for cesarean section. But it is strongly recommended to use the operation in the following cases:

Caesarean section completely eliminates the child’s contact with the mother’s genital tract, therefore, in the absence of HIV therapy, it can be considered an independent method of preventing infection. The operation can be performed after 38 weeks. Planned intervention is performed in the absence of labor. But it is possible to perform a caesarean section for emergency reasons.

During vaginal delivery, at the first examination, the vagina is treated with a 0.25% chlorhexidine solution.

After birth, a newborn must be bathed in a bath with aqueous chlorhexidine 0.25% in an amount of 50 ml per 10 liters of water.

How to prevent infection during childbirth?

To prevent infection of the newborn, it is necessary to provide HIV prevention during childbirth. Drugs are prescribed and administered to the woman in labor and then to the born child only with written consent.

Prevention is necessary in the following cases:

1. Antibodies to HIV were detected during testing during pregnancy or using a rapid test in the hospital.
2. According to epidemic indications, even in the absence of a test or the impossibility of conducting it, in the case of a pregnant woman using injecting drugs or her contact with an HIV-infected person.

The prophylaxis regimen includes two drugs:

• Azitomidin (Retrovir) intravenously is used from the onset of labor until the umbilical cord is cut, and it is also used within an hour after birth.
• Nevirapine - one tablet is taken from the moment labor begins. If labor lasts more than 12 hours, the drug is repeated.

In order not to infect the baby through breast milk, it is not applied to the breast either in the delivery room or subsequently. You should also not use breast milk from a bottle. Such newborns are immediately transferred to adapted formulas. A woman is prescribed Bromocriptine or Cabergoline to suppress lactation.

In the postpartum period, antiviral therapy is continued with the same medications as during gestation.

Preventing newborn infection

A child born to an HIV-infected mother is prescribed medications to prevent infection, regardless of whether the woman has been treated. It is optimal to start prophylaxis 8 hours after birth. Until this period, the drug administered to the mother continues to work.

It is very important to start giving medications in the first 72 hours of life. If a child becomes infected, the virus circulates in the blood for the first three days and does not penetrate the DNA of cells. After 72 hours, the pathogen is already attached to the host cells, so prevention of infection is ineffective.

Liquid forms of drugs for use by mouth have been developed for newborns: Azidotimidine and Nevirapine. The dosage is calculated individually.

Such children are registered at the dispensary until they are 18 months old. The criteria for deregistration are the following:

• no antibodies to HIV when tested by ELISA;
• no hypogammaglobulinemia;
• no symptoms of HIV.

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

Experts were sure that HIV infection and pregnancy- concepts are completely incompatible. And the possibility of transmission of infection from mother to baby frightened the HIV-infected women themselves. In addition, childbirth could pose a huge danger to the mother. However, in recent years, completely new means have appeared to combat HIV, and today a woman with a similar diagnosis is quite capable of conceiving, bearing and giving birth to an absolutely healthy child.

How to recognize HIV during pregnancy?

The incubation period of this disease can last from two weeks to several months, depending on the state of the immune system. First signs of HIV can be quite vague and most often women at an early stage simply ignore them. Most women learn about the diagnosis only in its acute phase, which is characterized by:

• strong increase in temperature;
• the appearance of muscle pain;
• unpleasant sensations in the joints and throughout the body;
• various types of gastric dysfunction;
• rashes on the skin, body and limbs;
• changes in the size of the lymph nodes.

Very often, a pregnant HIV-positive woman feels weakness, headache, chills, and fatigue. All these symptoms are also characteristic of completely healthy pregnant women. The acute stage gradually flows into the latent stage, when the disease practically does not manifest itself at all. In the absence of proper treatment, a woman’s immunity rapidly declines, and her body becomes especially susceptible to various viruses, fungi and infections.

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

Diagnosis of the disease

If you promptly determine the presence of HIV infection in an expectant mother, this will give her every chance to successfully conceive, carry and give birth to a healthy child. That is why it is so important to undergo a full examination at the stage of pregnancy planning. HIV infection can be detected using the following methods:

1. Polymerase chain reaction- for this it is necessary to draw blood, as well as examine the sperm and biological fluids of both partners. Thus, it is possible to establish the presence and type of HIV infection, if any, as well as its concentration. This method allows you to diagnose the disease within two weeks after the moment of infection.
2. Enzyme immunosorbent screening- the most commonly used and effective method for detecting HIV. To do this, partners donate venous blood to check for the presence of specific antibodies to HIV. If such testing gives a positive result twice, then the presence of infection is refuted or confirmed by a special additional test (immunoblot test).

Important! HIV diagnosis is recommended in the first trimester of pregnancy. However, the risk of disease transmission remains throughout pregnancy, so you should be examined at a later stage, as well as after the birth of the child.

Impact of HIV on pregnancy

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

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

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

Methods of transmission of HIV infection

Pregnancy in an HIV-infected woman must be carefully planned. However, it also happens that the expectant mother learns about her diagnosis while already pregnant. In this case, she will have to undergo a course of treatment with special drugs aimed at fighting the virus, regularly monitor the level of antibodies in the body, and also monitor the development process and condition of the unborn child.

Of course, the very combination of pregnancy and HIV is extremely dangerous for both the unborn child and the mother, but if a woman is ready to strictly follow all doctors’ instructions and has an understanding of the risks, she has every chance of becoming a happy mother.

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

1. Through the blood- during the gestation period, the fetus and the expectant mother have a common circulatory system, thus there is a possibility of transmission of infection while in the womb.
2. During labor- when the maximum permissible levels of infection are reached, there is a chance of HIV transmission during childbirth through amniotic fluid. In most cases, delivery in HIV-positive pregnant women occurs by cesarean section.
3. During breastfeeding- The baby can become infected with HIV from the mother during breastfeeding. The risk of transmission in this case is approximately 25%, since without special precautions, mother's milk contains a fairly high concentration of infection. Most often, HIV-infected mothers in labor prefer artificial feeding.

How to avoid passing HIV to your child?

Many families suffering from the human immunodeficiency virus express a desire to reproduce a child, sometimes even more than one. In this case, even the most seemingly insignificant details must be taken into account, since the possibility of infection of the fetus exists even during the process of conception. Of course, the reproductive cells of the parents cannot be a source of infection, but the infection is present in the fluids of both partners.

There are several ways to conceive relatively safely for such couples. In cases where only a woman is the carrier of the virus, she can undergo artificial insemination, namely, we are talking about artificial insemination. In families where the spouse is infected, you can resort to one of the following fertilization options:

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

Important! The safest method of conception for HIV-infected women is the method of artificial conception using healthy donor material. However, not all married couples are ready to take this step.

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

1. First of all, do not neglect taking HIV medications. As a rule, a woman with this terrible diagnosis must take medications that contain a certain substance aimed at fighting HIV throughout the entire period of pregnancy and after childbirth. Thus, the chance of transmitting the disease is significantly reduced.
2. Childbirth by caesarean section. In this case, it is possible to significantly minimize the child’s contact with the mother’s fluids. Natural childbirth in HIV-infected people is allowed, but only in certain cases.
3. Artificial feeding. An HIV-infected woman will most likely have to stop breastfeeding her baby. Today, on the shelves of children's stores there is a fairly wide range of food for newborns, which practically does not differ in properties from natural breast milk.

Is pregnancy dangerous for the woman herself?

According to statistics, pregnancy in most cases is not capable of negatively affecting the condition of an HIV-infected expectant mother. However, some anti-HIV drugs must be avoided during pregnancy because they are extremely harmful to the development of the fetus. In addition, like any healthy woman, a woman with HIV infection should pay special attention to her lifestyle throughout pregnancy, namely:

• completely give up bad habits - smoking and alcohol;
• do not take drugs;
• review your diet, making it as balanced as possible;
• Strictly follow the rules for taking medications aimed at combating HIV.

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

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

Modern medicine can reduce the likelihood of HIV transmission from mother to child to 2%. From now on, HIV is not a death sentence at all, and in our time this disease does not put an end to the dream of motherhood. You can give yourself and your spouse a completely healthy, strong baby, who will give you a lot of happiness and push negative thoughts about your illness into the background.

In the modern world, there is a tendency to increase the number of women who give birth with HIV infection. Moreover, not in every case, if the mother is HIV-infected, the child will be sick. This is due to the fact that thanks to timely preventive measures regarding an unborn baby, the likelihood of transmitting the virus can be reduced to 3%.

The situation is much worse if both parents have AIDS. In this case, there will be significant difficulties with conception, and if this happens, then in 90% of cases the child will be born infected.

Children born from HIV-infected mothers: clinical picture

Almost every family where there is one carrier of the immunodeficiency virus, when meeting with a doctor, asks the question: are HIV-infected people born healthy children? If perinatal prevention of HIV infection is followed, the birth of an uninfected baby is highly likely. If all efforts are directed in a timely manner to protect the child’s body from the penetration of the virus, then the risk of its transmission can be reduced to 3%. If this is not done, then the likelihood that the children of HIV-infected women will be infected increases to 30%.

To increase the chances of having a healthy child, all HIV-infected mothers are required to register with a doctor immediately after detecting pregnancy. The specialist will conduct an examination and prescribe special medications aimed at reducing the amount of virus in the blood, which will ultimately reduce the risk of transmitting the pathogen to the baby.

Another pressing question: what abnormalities can be diagnosed in children of HIV-infected mothers?

It is worth noting that if the birth of a healthy child was recorded from an HIV-infected mother, then in all respects it is equal to those children who were born from uninfected women. These kids are no different from their peers and develop in accordance with accepted norms.

If children from HIV-infected mothers are still born infected, then quite often they have anemia and malnutrition. Approximately half of these infants have low weight - up to 2.5 kilograms, and morphofunctional immaturity is observed. Approximately 80% of infected children are diagnosed with central nervous system dysfunction.

Perinatal HIV: prevention

To ensure that children born to HIV-infected mothers are healthy, women are required to undergo chemical prophylaxis no later than 14 weeks before the planned pregnancy. To exclude the perinatal route of HIV transmission, the patient is prescribed special antiretroviral treatment.

During the birth itself, the woman is given pre-selected drugs into a vein. A number of appropriate medications are also prescribed to newborns. This must be done no later than 42 days from the moment the baby is born. Next, the child of the HIV-infected mother is sent for a clinical blood test to determine whether anemia has begun to develop while taking medications.

HIV-positive woman gave birth to a child: monitoring the baby

After the birth of a child to an HIV-positive woman, he is examined in a children's clinic at his place of residence. You also need to take general tests (urine and blood) at this medical institution.

In addition, the birth of a child from an HIV-positive mother is accompanied by registration at the AIDS Center, where the baby is diagnosed with an “Inconclusive test for the human immunodeficiency virus.” Examinations in this institution are indicated until the child completely gets rid of the antibodies to the pathogen transmitted to him from his mother. As a rule, the frequency of tests is 4 times a year until the baby is 12 months old. Then the number of examinations is reduced by half.

Vaccination of children born from HIV-infected mothers is also a mandatory requirement. Vaccinations for healthy children are carried out according to the schedule. If a child is infected with a retrovirus, vaccination is carried out only with inactivated preparations; the introduction of components containing live pathogens is contraindicated.

Another important point that should never be forgotten is that a child from an HIV-infected mother can become infected during lactation. Therefore, regardless of whether the baby is healthy or not, he should not be fed milk from the breast of a sick woman. You should immediately select (preferably in consultation with a doctor) adapted milk formulas. Children of HIV-infected parents should eat the same as their peers. In addition, it is recommended to introduce more vitamins and microelements into the diet, especially if the child is infected.

Also, in the process of monitoring babies born from parents with the immunodeficiency virus, it is mandatory to undergo examination and prevent bacterial infections.

The following studies are required:

• PCR analysis to detect AIDS;
• immunoblotting to determine the presence of antibodies to the human immunodeficiency virus;
• determination of markers of hepatitis forms A and B;
• blood test for biochemistry.

After the child is one and a half months old, the use of medications aimed at preventing the development of pathologies that could arise as a result of perinatal contact with HIV infection in children ends. Next, the use of medications begins to prevent the development of Pneumocystis pneumonia. If a baby has been diagnosed with AIDS, then prevention of this disease is carried out until the child is 12 months old.

Children from HIV-infected fathers

If there is a discordant couple where the man is infected, the probability of giving birth to a healthy child is much greater than in cases where the woman is the carrier of the virus. This is due to the fact that there is no perinatal contact with HIV. That is, the mother cannot transmit the pathogen to the child during childbirth. Naturally, everything is not so simple here either, and a lot of effort will be required on the part of the man and woman.

The infected partner should do the following during pregnancy planning:

1. Continued use of ART drugs is necessary to reduce the viral load to a minimum.
2. Get tested for the presence of other infections in the body that can be transmitted sexually.
3. If secondary pathologies are detected, treat them.

The following activities must be carried out on the part of the woman:

1. Testing for sexually transmitted infections. If they are detected, treatment should be started immediately.
2. Monitor favorable days for conception (ovulation period). This can be done using special tests sold in pharmacies, or by consulting a gynecologist.

And of course, one cannot fail to note the procedure for cleaning male sperm. Using this manipulation, you can cleanse a man’s seminal fluid from viral cells.

But the above procedure has several disadvantages:

• lack of a 100% guarantee that sperm purification will lead to the birth of a healthy child;
• inaccessibility of the procedure on the territory of Russia and, accordingly, its high cost abroad.

If you follow all these measures, the risk of having an infected child is reduced to 2%. IVF is also possible. If a woman is not infected with a retrovirus, an alternative may be to use donor material. In this case, the probability of giving birth to an absolutely healthy baby is 100%.

HIV dissidents and their children

Today, the dissident movement is quite life-threatening - these are people who claim that the human immunodeficiency virus does not exist. This trend has claimed more than one adult and child’s life.

If healthy parents have a child infected with HIV, then they simply cannot believe it and, in addition to using medications, look for alternative ways of treatment. And at this moment, many stumble upon a movement of dissidents who insist that medications only worsen the baby’s condition. They also often claim that the child is completely healthy, and this diagnosis is an attempt by pharmaceutical companies to make a profit.

Under no circumstances should you buy into the assurances of representatives of this “sect,” because taking medications ensures that even HIV-infected people have healthy children. It should be remembered: what kind of children HIV-infected people will have - sick or healthy - directly depends on the parents themselves and their compliance with all preventive measures.