Pregnancy is wonderful moments, it is dreams and dreams, it is real happiness, especially if it is long-awaited. The expectant mother makes plans for how her life will change with the birth of the baby. And among all this, like a shot at point-blank range, a diagnosis of HIV can strike. The first feeling is panic. Life is crumbling, everything is flying head over heels, but you need to find the strength to stop and think hard. Pregnancy and HIV are not a death sentence. In addition, you must first confirm how reliable the diagnosis is.
Better late than later.
Indeed, for many women it is not clear why they need to be constantly tested for a variety of infections during pregnancy. After all, they have a happy family, and this certainly cannot happen to them. In fact, pregnancy and HIV very often go hand in hand. Just this disease is very insidious, it can be completely invisible for ten to twelve years. Even if there are a pair of seals (lymph nodes) on the neck, this may go unnoticed. In some cases, the temperature may increase slightly, a sore throat, vomiting and diarrhea may appear.
In order to identify the disease, special laboratory tests are needed. A thorough examination of the body of the expectant mother is necessarily included in the program for protecting motherhood and childhood. That is why pregnancy and HIV are two concepts that are often found together. Perhaps, if it were not for the interesting situation, then the woman would never have gone to the doctor.
Diagnostics
As already said, the only reliable way to diagnose is through 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 in the body at the same time should not remain without the supervision of a doctor.
The most popular diagnostic method is ELISA, with the help of which antibodies to HIV are detected in the patient's blood serum. PCR allows you to determine the actual cells of the virus in the blood. Usually this examination is carried out when there is already a suspicion of HIV in order to accurately diagnose.
If the doctor told 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 vitally important for you to work closely with your doctor, take tests and follow the recommendations.
Could there be an error?
Of course it can! That is why you need to undergo further examination, especially if you are confident in your partner. The fact is that the initial 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 are a blow for any expectant mother, however, it must be remembered that the results obtained are not completely reliable.
A false negative result may be if the infection occurred recently. That is, a person is already a carrier, but the body has not yet had time to react and develop protection, antibodies that doctors find. False positive analysis is even more common, especially in pregnant women. The reasons lie in the physiology of this difficult period. Of course, anyone will not be up 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.
Pregnancy
HIV and pregnancy can take their course without affecting each other too much. Pregnancy does not accelerate the progression of infection in women who are at an early stage of the 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 more often diagnosed.
An analysis of HIV during pregnancy is also necessary in order to assess the stage of development of the disease. By the way, if we compare mortality with the immunodeficiency syndrome of those giving birth and abandoning it (we are talking about aborting pregnancy after diagnosis), there are practically no differences.
However, as you already understood, the course of pregnancy very much depends on how long the disease develops, what stage it was at the time of conception, and also on the state of the body. The later the stage, the more complications may arise. This can be frequent and severe bleeding, anemia and premature birth, the birth of a dead child, low fetal weight, and postpartum endometritis. Thus, the more severe the disease, the less likely it is to endure and give birth to a healthy baby.
The clinical picture during pregnancy
This moment is especially important for those women who learned about their disease already during gestation. What is HIV like during pregnancy, what are the symptoms and treatment of this ailment in expectant mothers? These are questions, the answers to which could help many women to assess what is happening to them and take adequate measures. But, unfortunately, it is more or less difficult to describe them. The fact is that the immunodeficiency virus develops and progresses against the background of a weakening of the protective functions of the body. And the stronger the immune system recedes under its onslaught, the more pronounced the symptoms will be.
Usually, 6-8 weeks after infection, a person begins to experience the first signs that the expectant mother can easily take for a picture typical for pregnancy. At this time, increased fatigue, fever and decreased performance, as well as diarrhea, are possible.
What is the main difficulty? This stage does not last long - only two weeks, and the symptoms subside. Now the disease takes on a hidden form. The virus goes into the persistence stage. The period can be very long, ranging from two to 10 years. Moreover, if we talk about women, it is they who have a tendency to a long course of the latent stage, in men it is shorter and does not exceed 5 years.
During this period, all lymph nodes increase. This is a suspicious symptom that requires examination. However, here lies the second difficulty: an increase in lymph nodes during pregnancy is normal, and is very common in healthy people. However, this symptom should definitely alert the expectant mother. It’s better to be safe again than to lose valuable time.
Intrauterine development of the baby
In this matter, physicians were very interested in one point, namely, at what period the infection occurs. A lot of information for this was given by the tissues of spontaneous miscarriages and infected mothers. Thus, it was found that the virus is able to cause intrauterine infection in the first trimester, but the likelihood of this is not too high. In this case, children with the most severe lesions are born. 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.
An interesting fact is 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 even sent to a planned cesarean 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 pathways of infection. HIV-positive during pregnancy increases the risk of having a baby with a congenital immunodeficiency virus by 17-50%. However, antiviral treatment reduces the likelihood of perinatal transmission by 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 to the fetus are:
- late treatment when the disease has reached a late stage;
- infection during pregnancy;
- complicated pregnancy and difficult birth;
- damage to the skin of the fetus during childbirth.
Infection during childbirth
In fact, if the test for HIV during pregnancy is positive, 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 baby will also be HIV-positive. But so far, 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 body of the crumbs, and now it will be possible to say for sure whether the infection of the child has occurred.
A future mother should know that HIV during pregnancy can be transmitted to the baby even during fetal development. However, the higher the immunity in the mother, the better the placenta works, that is, the organ that protects the fetus from viruses and bacteria in the mother’s blood. If the placenta is inflamed or damaged, then the likelihood of infection increases. This is another reason why you need to undergo a thorough examination with your doctor.
But most often, infection occurs during childbirth. Therefore, pregnancy with HIV infection should be accompanied by mandatory antiviral therapy to minimize this likelihood. The fact is that during the passage through the birth canal, the baby has a great chance to come into contact with the blood, which sharply increases the possibility of infection. If you remember from the school course, this is the shortest way to transmit the virus. Caesarean section is recommended when a large number of viruses are detected in the blood.
After childbirth
As we already said, an HIV test during pregnancy is necessary so that in case of a positive result, the mother can undergo full therapy and maintain her state of health. During pregnancy, physiological suppression of the immune system occurs. Therefore, if the previous study examined only the period of pregnancy, others went further and found that after birth, the development of HIV can accelerate. Over the next two years, the disease can go into a much more severe stage. Therefore, one cannot rely solely on the desire to become a mother. Consultation with a doctor is mandatory at the planning stage. Only this approach can become your assistant. HIV-positive during pregnancy can seriously undermine health, which will subsequently lead to a reduction in the quality of life.
Breastfeeding and its dangers
Pregnancy of HIV-infected people can proceed very well when the baby develops normally and is born completely healthy. Of course, his mother’s antibodies will be contained in his blood, but they may not have an effect on children's immunity. However, now the mother has a choice whether to feed her baby with breast milk. The doctor must explain that breastfeeding almost doubles the risk of infection. So give it up, which will be the best choice. High-quality mixes will give the baby a much better chance for the future.
Your risks
There are a number of factors that may not be in your favor. This is primarily a weakening of the mother's immunity. A high viral load, that is, a large number of viruses in a woman’s blood, is also a bad sign. In this case, the doctor may suggest terminating the pregnancy. We 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 is also a risk factor.
First of all, the expectant mother needs to be registered as early as possible. Be sure to follow all the recommendations of your doctor, then you will have a better chance of having a healthy baby. Starting from the 14th week, a pregnant woman can take the antiviral drug "Azidothymidine" or its analogue. She receives such prevention absolutely free. If a woman for several reasons did not take it before the 34th week, then it is necessary to start doing this at a later date. However, the earlier treatment is started, the less likely a mother to transmit the disease to her baby.
Treatment
HIV therapy during pregnancy requires careful weighing of the condition of the mother and gestational age. That is why leave it to an experienced doctor and in no case try to self-medicate. If you consulted a specialist before pregnancy, at the time of its planning, then most likely you will be prescribed combination therapy. The decision about its beginning is made on the basis of two analyzes - this is the level of CD-4 cells and viral load. Modern treatment requires the simultaneous use of two or more antiviral drugs.
The HIV test (pregnancy is the reason to cancel combination therapy) is the starting analysis on which all further treatment is based. For the future mother, only one antiviral drug is left to prevent infection of the crumbs.
If a woman took combination therapy before pregnancy, then in case of the onset she is recommended to take a break in 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 increase at the discretion of the doctor. The rest of the treatment is symptomatic. This allows you to reduce the risk of malformations of the future baby, as well as to avoid the terrible state of resistance, in which the virus can no longer be treated.
What should a woman remember
Despite the fact that the achievements of modern medicine can reduce the risk of infection of a child from his own mother to 2%, he still exists. Therefore, you need to weigh the pros and cons, because a woman, even being HIV-infected, wants to endure and give birth to a healthy baby. The difficulty is that you will not find out if your baby was born HIV-positive for a long time, and this cannot be predicted in advance. So you have a long and tedious wait. ELISA will give a positive result about 6 months after delivery, so be patient.
When deciding to give birth, a woman should know what awaits her child if he falls into these unhappy 2%. We remind you that such a minimal probability of having a baby with an immunodeficiency virus is possible only if the woman did not follow all the recommendations of the doctors, did not undergo constant examinations and did not take the drugs exactly according to the scheme.
The hardest part is HIV in those babies who are infected in utero. Symptoms in this case are much more pronounced, and often such children do not live up to one year. Fewer manage to meet the teenage period, but to predict their life in adulthood can only be hypothetically, since so far there have been no such cases.
HIV infection during childbirth or breastfeeding is somewhat easier, because the virus lays on the already formed organism with a developing immune system. However, the lifespan of a child will be very limited. Doctors usually do not make prognosis for more than 20 years.
Prevention
Congenital HIV infection has been hospitals and medicines since childhood. Of course, everything must be done to prevent such a development of events. Therefore, it is very important to conduct timely prevention of this disease. Today, this work is carried out in three directions. First of all, it is HIV prevention among women of childbearing age. The second area is the prevention of unwanted pregnancies among women with HIV. Finally, the last is the prevention of transmission of infection from a woman to her child.
A positive HIV test during pregnancy is not the end of the world. However, a woman should be aware that she has a chance to infect a baby. Modern therapy has greatly increased the life expectancy of an HIV-positive person. Many live 20 years or more from the time of infection. However, if for an adult this is a whole life, then for a child is a chance to meet youth and leave. The achievements of doctors do not relieve women of responsibility, therefore, first of all, each of them should think about the future of their baby.
Instead of a conclusion
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