The viruses currently identified with certainty, HIV 1 and HIV 2, are transmitted sexually, through blood, and from mother to child. In case of seropositivity, breastfeeding is contraindicated, as the virus can be transmitted through mother's milk.

HIV infection is a viral chronic progressive disease that develops in certain stages and affects the immune, nervous and other human systems.

The main and most frequent complication during pregnancy is infection of the baby (30-60% of cases). If an HIV-infected expectant mother conducts pregnancy under the strict supervision of medical specialists, fulfills all the necessary appointments, the risk of infection of the child is sharply reduced (up to 8%)!

Breastfeeding the baby in this case is not allowed.

HIV infection is often accompanied by skin lesions. Pregnancy usually does not affect the skin manifestations of the disease, but the ability to recognize them in a timely manner is extremely important. If a pregnant woman knows she is infected, she can take steps to reduce the risk of infection to the fetus. Although antenatal testing for HIV infection is recommended for all pregnant women, the diagnosis is sometimes made after the onset of symptoms or a history of symptoms.

Antiretroviral therapy, planned caesarean section, and abstinence from breastfeeding reduce the risk of mother-to-fetal transmission of HIV-1 from 35% to 2%.

Folliculitis

HIV infection is accompanied by lesions of the hair follicles. The most characteristic of HIV infection is eosinophilic folliculitis, which essentially has a diagnostic value. It is manifested by itching, excoriations, follicular papules and pustules on the linden, trunk and arms. Treatment includes systemic antibiotics, phototherapy, and 13-cisretinoic acid. Other lesions include folliculitis caused by Staphylococcus aureus and Pityrosporum ovale. In persons with dark skin color, after the resolution of the inflammatory process, pigmentation remains.

Kaposi's sarcoma

Kaposi's sarcoma is commonly seen in gay men but can also occur in women, especially in areas of high HIV infection. A significant role in the etiology of Kaposi's sarcoma is played by herpesvirus type 8. The tumor usually develops with advanced HIV infection, against the background of severe immunosuppression, but it is also possible at an early stage of the disease. On the skin, it appears as purple-brown spots, nodules or plaques. Kaposi's sarcoma can also develop in the oral cavity, it is also possible to damage the lungs with a poor prognosis. Histological examination allows confirming the diagnosis and differentiating Kaposi's sarcoma with bacterial angiomatosis. Treatment includes radiation therapy and chemotherapy (local or systemic), as well as highly active antiretroviral therapy (HAART).

VZV infection

In patients with herpes zoster, HIV infection should be excluded. Herpes zoster can appear early in an HIV infection when there are no other symptoms. With severe immunodeficiency, several areas of the skin are often affected. Atypical manifestations of VZV infection include warty growths and painless ulcers. With recurrent or prolonged course of herpes zoster, long-term therapy with acyclovir may be necessary.

Damage to the external genitalia

The appearance of genital warts may be associated with immunosuppression, therefore, with multiple genital warts, difficult to treat, and multifocal intraepithelial neoplasia of the cervix, HIV infection should be excluded. In severe immunodeficiency, the lesion is common.

Other diseases

Other diseases commonly seen in HIV-infected people include molluscum contagiosum, seborrheic dermatitis, ichthyosis, scabies, and psoriasis. Relatively recently, cases of cryptococcosis and histoplasmosis have also become more frequent.

Transmission from mother to fetus

The HIV virus can be transmitted to the fetus from an infected mother at the end of pregnancy or during childbirth. In the absence of medical treatment, the risk is 20 to 30% and varies depending on the stage of the disease. Various treatments are offered to reduce the risk of fetal infection; they have shown to be effective, but do not completely eliminate the risk (3%).

After birth

A child born to an infected mother (carrier of the virus) is always seropositive, but is not necessarily a carrier of the virus. In fact, all of the mother's antibodies are passed on to him, including those directed against HIV, but he is always seropositive from birth until about 6 months of age. The child will be regularly examined and, if necessary, treated in specialized centers.

When the mother is seropositive, the child is tested from birth (detection of the presence of a culture of the virus or its genome) to determine whether it has been infected and to begin, if necessary, immediate antiviral treatment.

HIV and breastfeeding

The virus can be transmitted through mother's milk, so breastfeeding is not recommended.

HIV prevention during pregnancy

The only way to fight the epidemic that this virus provokes is prevention (among other things, the use of condoms), since today there is still no effective treatment that would cure an infected person. At present, doctors in our country can say with confidence that we are beginning an epidemic of the human immunodeficiency virus (HIV), which causes AIDS. The picture is sad, because now HIV is found not only among high-risk groups (homosexuals, drug addicts, prostitutes), but among fairly well-to-do people from well-to-do strata of the population. If at the beginning of the 1990s Since the number of infected people and HIV carriers was represented mainly by the male population of the country, in the current situation, more than 80% of HIV carriers are young and middle-aged women capable of giving birth to children, so the issue of pregnancy and HIV infection is acute. AIDS is the terminal stage of the disease, in which a host of other diseases arise from which a person dies, it is with AIDS that pregnancy and the ability to bear a fully developed child are almost impossible. HIV infection is a disease that is steadily spreading in the body, caused by a special virus HIV-1 and HIV-2, which affects the human immune system, as a result, the body loses the ability to fight other diseases and dies from them.

The average life expectancy for HIV infection, even with adequate treatment, is an average of fifteen years. In this case, the person himself dies not from HIV, but from other diseases that suppressed immunity cannot cope with. The HIV-1 virus is common among the population of the European and American continents, and HIV-2 - among the African population. HIV is a fairly complex virus that has special substances that allow it to enter the human body, settle in the cells of the immune system and gradually destroy them during reproduction. A virus is a special microorganism, but not a cell, but a part of a cell that can only exist in the host's body, use the host's cells for its life and reproduction, since the virus does not have many important structures.

HIV infection affects only humans. The source of the disease is a sick person at any stage of the disease. Most often, the disease occurs during unprotected sexual contact, transfusion of blood components and donor blood, various medical procedures using instruments, organ transplantation, artificial insemination, intravenous injections, tattooing, manicure and pedicure, in which microdamage to the skin occurs and the virus penetrates through infected instruments. etc. In pregnant women with HIV infection, the child can be infected both inside (through the placenta) and during breastfeeding. Accordingly, pregnant women, as well as non-pregnant women, should avoid the risk of infection under these conditions. The most important hygiene of sexual relations, the presence of one partner. Women need to remember that a sexual partner is not obliged to tell a woman about HIV infection, since this is his personal right, and none of the doctors will tell you about his illness.

The penetration and impact of the virus on humans

The virus in a woman's body is detected by special cells of the immune system responsible for eliminating "strangers" - macrophages that eat it. These cells carry it throughout the body and all organs. The virus leaves them and migrates to lymphocytes (it is most comfortable in them) here it lives and multiplies, having multiplied, it and its offspring penetrate into new cells, and the former owners die. In this way, almost all cells gradually die, and new ones do not appear, since they are initially infected and abnormal.

The progression of the disease over time is expressed in different ways: in some cases, HIV turns into AIDS after 2-3 years, but there is also a slow option (without treatment, life expectancy is ten to twelve years). In a normal human body, there are about 1000 cells of the immune system. At the first stages of a viral infection, 800 cells remain, which is still enough to protect the body and the infection does not manifest itself: the person feels quite healthy. Then, during each year, another 50-60 cells die, and when their number is reduced to 300, a person begins to die from other diseases. It will take about 10 years before such a finale.

Currently, the following classification of stages of the disease has been adopted in medicine: the period of penetration of the virus into the body (a few months); the period of primary manifestations: an infected woman may complain of a rise in temperature, which is not reduced by any drugs, the appearance of a quickly passing rash; a woman can find herself with an increase in lymph nodes, bulging in the form of peas under the lower jaw, in the armpits, etc .; violation of the chair (liquid and frequent); stomach ache; frequent appearance of herpes on the lips or in other places. In a word, there can be a variety of complaints, but women do not always pay special attention to them and do not go to the doctor. This period lasts for several weeks, then all phenomena disappear. Then comes a latent, or latent, phase, when there are no manifestations of the disease, its duration depends on the rate of reproduction of the virus in the body and the death of cells of the immune system. The final stages of the manifestation of the disease are considered stages 4A, 4B and 4C. All complaints characteristic of this period of the disease are associated with a very low content of immune cells, for example, at stage 4A there are only 350-500 cells, at stage 4B - up to 350, and at stage 4B - less than 200 (sometimes the fifth stage is also distinguished, when the cells become less than 50).

Clinic of HIV infection and AIDS during pregnancy

The primary stage of the disease proceeds without any special complaints, or there are complaints, but they are characteristic not only for HIV infection, but also for other diseases. Some women will complain of a slight fever, manifestations of sore throat, pain when swallowing, the appearance of a small rash that quickly disappears. The woman herself can feel enlarged lymph nodes in her neck, in the armpits and other places. They are felt as rounded formations under the skin, mobile, painless, about 1 cm in size. During this period of the disease, women feel quite healthy, lead an active lifestyle, unaware of their disease. Manifestations of stage 4A are a decrease in body weight up to 10 kg, which can please a woman. Women often suffer from acute respiratory viral infections, tonsillitis and other respiratory diseases. When the disease (in the absence of treatment) slowly progresses to stage 4B, women begin to turn to many specialists about the occurrence of various diseases. The following diseases appear immediately.

Seborrhea-like dermatitis - complaints of severe itching and burning of the scalp, the appearance of profuse dandruff, a feeling of dry hair.

Pyoderma is a disease that manifests itself in the form of the appearance of a large number of pustules on the skin of the face and trunk. Despite the ongoing treatment, pustules appear again and again.

Candidiasis of the mucous membranes - due to the development of the Candida fungus, manifested by damage to the vaginal mucosa (thrush), damage to the oral mucosa and digestive system. Women will complain of itching and burning at the site of fungus breeding, copious discharge in the form of small crumbling curdled masses, the separation of which shows an inflamed surface. With vaginal candidiasis, women complain of pain during intercourse, an unpleasant specific smell. Very often, in women in the 4A stage of the disease, the herpes simplex virus is activated, which manifests itself with frequent rashes not only on the lips, but also on other parts of the body that were previously free from it. Shingles virus from the herpes family of viruses is also activated. There are herpes-like rashes along the branches of nerve endings, accompanied by itching and burning, pain. A woman loses more than 10 kg in weight. Whitish spots appear on the tongue, “shaggy” in appearance - a “hairy” leukoplakia of the tongue develops. Very often, women develop all kinds of fungal infections, such as fungal infections of the nails of the hands and feet, the skin of the feet and head. Characteristic of HIV infection and respiratory diseases: pneumonia, which is rather severe and difficult to treat. The final 4B and 5th stages are characterized by the development of opportunistic diseases (diseases that cannot develop in healthy people) caused by their own bacteria. Such infections include pneumocystis pneumonia, Kaposi's sarcoma and other diseases, during the development of which sick people die. Disorders of the nervous system are very characteristic of HIV infection: many have impaired skin sensitivity to various stimuli, increased motor activity (hyperkinesis) of individual muscle groups, or, conversely, a decrease or inhibition of muscle activity (paresis). The organ of vision can be affected up to blindness.

Kaposi's sarcoma is a malignant tumor of the blood vessels, usually in the arms, trunk, or face. HIV infection poses a serious threat to pregnant women and their children. It is very important for diagnosing the possibility of bearing a fetus and its normal development, the time of infection of the mother. For example, if a woman has been infected with HIV long before pregnancy (1-4 years), while she receives good treatment with the most modern drugs, then she has a very high chance of giving birth to a healthy child. This pregnancy should be planned, the mother of the child should not have bad habits, lead a healthy lifestyle and receive a modern treatment regimen, then the probability of having a healthy and full-fledged child is about 98-99%. A child born from such a mother is strictly monitored by doctors from AIDS centers for the next year and a half; if he does not have antibodies to the disease, he is removed from the risk register and recognized as healthy. All mothers with HIV infection cannot breastfeed their baby due to the possibility of infection. If a woman is pregnant and becomes infected with HIV during pregnancy, then the question of treatment arises. A timely diagnosis and timely treatment may not affect the child, but infection of the child may also occur. In such cases, the child is born outwardly quite healthy, but already HIV-infected, or the pregnancy is terminated. If left untreated, pregnancy only worsens the condition of the woman, the infection progresses rapidly. A woman herself can die in a fairly quick time frame, she will most likely have to terminate the pregnancy. For the child himself (as well as for the mother), the greatest danger is not the HIV virus itself, but other microorganisms that are activated when the immune system is suppressed. For example, pathogens of the TORCH-complex of diseases. For all expectant mothers, a healthy and proper lifestyle, regular visits to antenatal clinics should be in the first place, the health of their babies depends on this. Women with HIV infection should not despair: if they follow all the recommendations of doctors, then the birth of a healthy child is quite possible.

Currently, there are about 40 million people with HIV infection in the world. When the new disease was first discovered, people with HIV were treated like suicide bombers. This was due to the late detection of HIV in patients, most of whom were already at the stage of AIDS (the end stage of the development of HIV infection) and lived no more than a year from the moment of diagnosis. Now, a timely diagnosis and competent treatment can delay the development of the disease for a long time. Therefore, women with HIV today can also experience the joy of motherhood - of course, subject to careful medical supervision and treatment.

The causative agent of the disease

HIV belongs to the Retriviridae family, subfamily Lentivirus. Justifying its name (Lentivirus in Latin "slow" virus), HIV is in no hurry.

Once in the body, HIV attacks certain blood cells - T-lymphocytes. These cells play an important role in the immune system: they recognize various foreign agents (bacteria, viruses, cancer cells and toxins) and order other cells to destroy them. On the surface of these lymphocytes are CD-4 molecules, therefore they are also called CD-4 cells. The virus encounters a cell with a CD-4 molecule on its surface, the shell of the virus and the cells merge, and the genetic material of the virus enters the cell, integrates into the nucleus and begins to control it until the cell dies. By the time HIV infection develops into AIDS, billions of blood cells already contain the genetic material of the virus.

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

HIV symptoms

When HIV enters the human body, the immune system fights the disease for many years. For a long time, only special blood tests can determine the presence of HIV, as well as how successfully the body fights the virus.

Only in some cases, immediately after infection, symptoms of HIV are present. The first signs of HIV are implicit: a few weeks after infection, a person may have a slight fever, swollen lymph nodes, sore throat, and diarrhea. Such symptoms are most often mistaken for signs of a cold or poisoning, especially since they disappear fairly quickly.

The presence of HIV in the body can be completely invisible for 10-12 years. The only thing that can bother a person is a slight increase in lymph nodes. When the number of CD-4 cells (those same T-helper cells) decreases sharply, specific diseases associated with immunodeficiency appear. Such diseases are frequent pneumonia, cytomegalovirus infection, herpes. In patients at this stage, such infections quickly become generalized (common) forms and lead to death. This stage of the disease is called AIDS.

Diagnostics

The only reliable method for diagnosing HIV infection is laboratory testing. During pregnancy, an HIV blood test is offered to all women three times during pregnancy. Tests cannot be ordered without the consent of the patient. But you need to understand that the sooner the correct diagnosis is made, the more chances the patient has to live a long life and give birth to a healthy child, even being a carrier of HIV. The doctor observing the pregnant woman is obliged to tell her about this, he must also explain the benefits of timely diagnosis of HIV in pregnant women.

The most common method for diagnosing HIV infection is enzyme-linked immunosorbent assay (ELISA), which detects antibodies to HIV in the patient's blood serum. ELISA can give both false negative and false positive results. A false-negative ELISA result is possible with fresh infection, while antibodies to HIV have not yet been developed by the patient's body. False-positive results can be obtained when examining patients with chronic diseases and in some other cases. Therefore, when a positive ELISA result is obtained, it must be rechecked with more sensitive methods.

The polymerase chain reaction (PCR) allows you to directly determine the presence of the virus. Using PCR, the amount of free viruses circulating in the blood is determined. This number is referred to as the "viral load". Viral load indicates how active the virus is in the blood. PCR, as well as ELISA, can give a false positive result. Therefore, when obtaining positive results, in addition to the methods listed, other diagnostic methods are also used.

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

The course of pregnancy

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

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

Congenital HIV infection

Mother-to-child transmission of HIV is an established fact. In the absence of special antiviral therapy, infection of children occurs in 17-50% of cases. Antiviral treatment significantly reduces the rate of perinatal transmission of the disease (up to 2%). Factors that increase the likelihood of HIV transmission are: late stage of the disease, infection during pregnancy, premature birth, damage to the skin of the fetus during childbirth.

Transmission of HIV can occur in three ways: transplacental, during childbirth or after childbirth through mother's milk. The placenta normally protects the fetus from bacteria and viruses found in maternal blood. However, if the placenta is inflamed or damaged, its protective function is affected and HIV infection can be transmitted from mother to fetus. Most often, HIV is transmitted during childbirth. During passage through the birth canal, the infant is exposed to the mother's blood and vaginal secretions. Unfortunately, caesarean section is also not a reliable protection of the fetus from HIV infection; its use is justified when a large number of viruses are detected.

The third route of transmission of the virus to a newborn is breastfeeding, which doubles the risk of infection. Therefore, an HIV-infected woman should not breastfeed her baby.

Children born to HIV-positive mothers will also be HIV-positive immediately after birth. However, this does not mean that they are infected, as children are born with their mothers' antibodies. Maternal antibodies disappear from the baby's blood between 12 and 24 months. It is through this time that it is possible to judge with certainty whether the infection of the child has occurred. PCR diagnostics helps to determine the child's HIV status earlier. Already 4 weeks after birth, the reliability of PCR is 90%, and after 6 months - 99%.

The likelihood of an HIV-positive diagnosis in children can also be indicated by certain diseases of newborns: pneumonia caused by pneumocystis, systemic candidiasis (fungal infection of many organs and systems), herpes zoster, chronic diarrhea, tuberculosis. Approximately 20% of infected children develop a severe form of immunodeficiency by the year, with the development of concomitant infections and, in many cases, encephalopathy (brain damage). Most of them die before reaching the age of five. In the remaining 80% of children, on the contrary, immunodeficiency develops after a period of time that exceeds the same duration of such a period in adults.

Treatment during pregnancy

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

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

If a woman took combination antiviral therapy before pregnancy, then doctors usually recommend that she take a break in treatment for the first three months of pregnancy. This reduces the risk of developing malformations in the unborn child, and in addition, to avoid the development of resistance (a condition in which the virus does not treatable).

Prevention

Prevention of congenital HIV infection is carried out in three ways:

1) HIV prevention among women of childbearing age;

2) prevention of unwanted pregnancies among women with HIV;

3) prevention of HIV transmission from mother to child.

Currently, thanks to combination antiviral therapy, people with HIV live for many years, some for more than 20 years. Many women with HIV do not want to miss the opportunity to become mothers. Therefore, prevention of mother-to-child transmission of HIV has become a central element of most government HIV programs.

HIV and AIDS

The first information about HIV infection (human immunodeficiency virus) appeared in the mid-80s of the last century, when an unknown disease was discovered in which adults suffered from immunodeficiency, which had previously occurred only as a congenital defect. In contrast to the immunodeficiency of newborns, in these patients, a decrease in immunity was acquired in adulthood. Therefore, the disease in the first years after its discovery began to be called AIDS - acquired immune deficiency syndrome.

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

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 the child is born infected in 90% of cases.

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 healthy children born to HIV-infected people? If perinatal prevention of HIV infection is observed, the appearance of an uninfected baby is possible with a high degree of probability. If all forces 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 pregnancy is detected. The specialist will conduct an examination and prescribe special drugs aimed at reducing the amount of virus in the blood, which ultimately will reduce the risk of transmitting the pathogen to the baby.

Another topical question: what deviations in children from HIV-infected mothers can be diagnosed?

It is worth noting that if the birth of a healthy child was recorded in 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 standards.

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

Perinatal HIV: Prevention

In order for children born to HIV-infected mothers to be 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, a woman is injected with pre-selected drugs into a vein. A number of appropriate funds are prescribed for newborns. This must be done no later than 42 days after the birth of the baby. Next, the child of an HIV-infected mother is sent for a clinical blood test to determine whether anemia has begun to develop while taking medications.

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

After the birth of a child in an HIV-positive woman, his examination is carried out in the children's polyclinic at the place of residence. It is also necessary to take general tests (urine and blood) in this medical institution.

In addition, the birth of a child from an HIV mother is accompanied by registration at the AIDS Center, where the baby is diagnosed with “Inconclusive test for the human immunodeficiency virus”. The passage of examinations in this institution is indicated until the child completely gets rid of the antibodies to the pathogen transmitted to him from the mother. As a rule, the frequency of testing 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 to HIV-infected mothers is also a prerequisite. Immunizations for healthy babies are carried out according to the schedule. If the 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 pick up (preferably after consulting a doctor) adapted milk mixtures. Children of HIV-infected parents should eat the same as their peers. In addition, it is recommended to introduce more vitamins and minerals into the diet, especially if the child is infected.

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

The following studies are required:

• PCR analysis for the detection of AIDS;
• immune blotting 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 drugs aimed at preventing the development of pathologies that could result from perinatal exposure to HIV infection in children is completed. Then the use of drugs begins to prevent the development of pneumocystis pneumonia. If the baby was diagnosed with AIDS, then the prevention of this disease is carried out before the child is 12 months old.

Children from HIV-infected fathers

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

The infected partner must do the following when planning to conceive:

1. Continued use of antiretroviral drugs is necessary to reduce the viral load to a minimum.
2. Take tests for the presence in the body of other infections, the transmission of which is possible through sexual contact.
3. If secondary pathologies are found, treat them.

On the part of the woman, the following actions should be performed:

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

And of course, it is impossible not to note the procedure for cleaning male sperm. With the help of this manipulation, it is possible to purify the seminal fluid of a man 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;
• the unavailability of the procedure in Russia and, accordingly, its high cost abroad.

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

HIV dissidents and their children

Today, the movement of dissidents is quite life-threatening - these are people who claim that the human immunodeficiency virus does not exist. This direction has claimed more than one adult and children's life.

If a child of healthy parents is HIV-infected, then they are simply unable to believe it and, in addition to using medications, they are looking for alternative ways of treatment. And at this moment, many stumble upon a movement of dissidents who say that drugs only worsen the condition of the baby. They also often claim that the child is completely healthy, and this diagnosis is an attempt by pharmaceutical companies to make a profit.

In no case should you buy into the assurances of representatives of this "sect", because taking drugs ensures that even HIV-infected people give birth to healthy children. It should be remembered: what kind of children HIV-infected will have - sick or healthy - directly depends on the parents themselves, their compliance with all preventive measures.

Statistics show 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 in childbirth from mother to child and breastfeeding. The disease is controllable, but a complete cure is impossible. Therefore, pregnancy with HIV infection should be under the supervision of a doctor 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 rapidly and infects a large number of cells during the day, 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, opportunistic flora is activated in HIV-infected people, and any infection proceeds atypically and with complications.

The high variability of the pathogen, the ability to lead to the death of T-lymphocytes allows you to get away from the immune response. HIV quickly forms resistance to chemotherapy drugs, so at this stage in the development of medicine, it is not possible to create a cure for it.

What signs indicate the disease?

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

At the stage of incubation, the disease does not manifest itself. The duration of this period is different - from 5 days to 3 months. Some already after 2-3 weeks are worried about the symptoms of early HIV:

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

After 1-2 weeks, these symptoms subside. The quiet period can last for a long time. For some it takes years. The only signs may be recurrent headaches and permanently enlarged, painless lymph nodes. Skin diseases such as psoriasis and eczema can also join.

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

Management of pregnant women

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

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

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

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

• spontaneous miscarriages;
• antenatal fetal death;
• joining STIs;
• premature;
• low birth weight;
• postpartum infections.

Examinations during pregnancy

All women are tested for HIV when they are registered. A re-examination 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 in time with the end of the seronegative period, when it is impossible to detect the virus.

A positive HIV test during pregnancy warrants referral to an AIDS center for further diagnosis. But only one express test for HIV does not establish a diagnosis; this requires an in-depth examination.

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

The situation is much worse when a false-negative analysis is obtained. This can happen when blood is taken during the seroconversion period. This is the period of time when infection 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 a legal termination of pregnancy. If she decides to keep the child, then further management is carried out simultaneously with the specialists of the AIDS Center. The need for antiretroviral (ARV) therapy or prophylaxis is decided, the time and method of delivery are determined.

Plan for women with HIV

For those who were already registered as 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 the main routine examinations, an ELISA for HIV, an immune blotting reaction is required. The viral load is determined, the number of CD lymphocytes. The specialist of the AIDS Center gives advice.
2. At 26 weeks, the viral load and CD4 lymphocytes are re-determined, a general and biochemical blood test is given.
3. At 28 weeks, a specialist from the AIDS Center consults a pregnant woman, selects the necessary AVR therapy.
4. At 32 and 36 weeks, the examination is repeated, the AIDS Center specialist also advises the patient on the results of the examination. At the last consultation, the term and method of delivery are determined. If there are no direct indications, then preference is given to urgent delivery through the natural birth canal.

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

When is urgent analysis needed?

In some cases, an express HIV test at the maternity hospital may be prescribed. This is necessary when:

• the patient was never examined during pregnancy;
• only one analysis was passed when registering, there was no second test at 30 weeks (for example, a woman comes with a threat of preterm birth at 28-30 weeks);
• the pregnant woman was tested for HIV at the right time, but she has an increased risk of infection.

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

The risk of vertical transmission of the pathogen during childbirth is up to 50-70%, while breastfeeding - up to 15%. But these figures are significantly reduced by the use of chemotherapeutic drugs, with the refusal of breastfeeding. With a properly selected scheme, a child can get sick only in 1-2% of cases.

Antiretroviral drugs for prevention are prescribed to all pregnant women, regardless of clinical symptoms, viral load and CD4 count.

Prevention of transmission of the virus to the child

Pregnancy in HIV-infected people takes place under the guise of special chemotherapy drugs. To prevent infection of the child, use the following approaches:

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

If a woman has a pregnancy 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 the period of bearing a child and after his birth.

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

Treatment at the initial detection of the disease

If HIV is detected during gestation, treatment is prescribed depending on the time when this happened:

1. Less than 13 weeks. ART drugs are prescribed if there are indications for such treatment until the end of the first trimester. For those who are at high risk of fetal infection (with a viral load of more than 100,000 copies / ml), treatment is prescribed immediately after the tests. In other cases, in order to exclude a negative effect on the developing fetus, with the start of therapy, it is timed until the end of the 1st trimester.
2. Term from 13 to 28 weeks. If the disease is detected in the second trimester or an infected woman applied 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. Use the scheme of three antiviral drugs. If treatment is first started after 32 weeks with a high viral load, 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;
• a protease inhibitor;
• or a non-nucleoside reverse transcriptase inhibitor;
• or an integrase inhibitor.

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

Therapy in patients previously treated with antiviral drugs

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

With the effectiveness of the scheme used before gestation, there is no need to change it. The exception is drugs with a proven danger to the fetus. In this case, the replacement of the drug is made on an individual basis. Efavirenz is considered the most dangerous of those for the fetus.

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

Prevention in childbirth

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

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

Choice of 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 performed through the natural birth canal in the case when the woman in labor received ART during pregnancy and the viral load at the time of delivery is less than 1000 copies/ml.

Be sure to note the time of the outflow of amniotic fluid. 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 gap of more than 4 hours. For an HIV-infected woman in labor, this is unacceptable. With such a duration of the anhydrous period, the likelihood of infection of the child increases significantly. A long waterless period is especially dangerous for women who have not received ART. Therefore, a decision can be made to complete the birth by.

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

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

Also do not carry out labor induction and labor intensification. All this significantly increases the chances of infection of the child. It is possible to carry out the listed procedures only for health reasons.

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

Caesarean section completely excludes the contact of the child with the discharge of 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 carry out a caesarean section and according to emergency indications.

In childbirth through the natural birth canal, at the first examination, the vagina is treated with a 0.25% solution of chlorhexidine.

A newborn after childbirth 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 carry out HIV prevention during childbirth. Drugs are prescribed and administered to a woman in labor and then to a newborn 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 a 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 injecting drugs or her contact with an HIV-infected person.

The prevention scheme includes two drugs:

• Azitomidine (Retrovir) intravenously, is used from the moment labor begins until the umbilical cord is cut, and it is also used within an hour after childbirth.
• Nevirapine - one tablet is drunk from the moment of the onset of labor. With a duration of labor of more than 12 hours, the drug is repeated.

In order not to infect the child through breast milk, it is not applied to the breast either in the delivery room or subsequently. Also, bottled breast milk should not be used. Such newborns are immediately transferred to adapted mixtures. A woman is prescribed Bromkriptine or Cabergoline to suppress lactation.

The postpartum woman in the postpartum period continues antiviral therapy with the same drugs as during the gestation period.

Prevention of infection in the newborn

A child born to an HIV-infected mother is given drugs 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 that was administered to the mother continues to act.

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

For newborns, liquid forms of drugs have been developed for use by mouth: Azidothymidine and Nevirapine. The dosage is calculated individually.

Such children are under dispensary registration up to 18 months. The criteria for deregistration are as follows:

• no antibodies to HIV in the study by ELISA;
• no hypogammaglobulinemia;
• no symptoms of HIV.

The source of HIV infection in pregnant women is infected people, regardless of the stage of the disease. The virus is transmitted through biological fluids - vaginal secretions, blood, semen, so the main routes of infection are:

• sexual contact with infected partners, as well as artificial insemination with seminal fluid from an infected donor;
• transfusion of blood or its components;
• an infected medical instrument that has not been properly processed;
• organ transplantation from infected donors.

Symptoms

The first signs of HIV infection begin to appear after the incubation period of the disease is over. That is, after 2 weeks - six months or more after infection. Symptoms of HIV may appear once and go away even without additional treatment, and then do not manifest themselves for several years. In the acute phase of pathology in pregnant women, the following symptoms appear:

• heat;
• enlarged lymph nodes;
• the occurrence of a rash on different parts of the body;
• pain in the joints and muscles;
• prolonged diarrhea.

The asymptomatic stage usually occurs after an exacerbation of the disease. It can last until the development of AIDS, for several years. Also, after the asymptomatic stage, the chronic phase of the immunodeficiency virus may develop, in which a person develops various pathologies of a fungal, bacterial and viral nature. This phase can last for 3-7 years or more. During it, the same signs are observed as during an exacerbation of the pathology. In addition, the person begins to lose weight.

Diagnosis of HIV infection during pregnancy

It becomes impossible to diagnose the immunodeficiency virus at an early stage, due to the fact that the symptoms of this disease at this stage correspond to the signs of other pathologies, which are often not given much importance. But in pregnant women, an analysis for the presence of HIV infection is carried out without fail. Usually, expectant mothers undergo a PCR test, which allows the detection of an RNA virus at an early stage in the development of HIV. Also, the doctor may prescribe an enzyme immunoassay. If it gives a positive result, immunoblotting is used - a diagnostic method that allows you to identify specific antibodies to the main antigens of the virus. If HIV is detected in a pregnant woman, it is required to consult with an infectious disease specialist and an obstetrician-gynecologist.

Complications

The main complication of HIV infection in a pregnant woman is AIDS. It is characterized by the development of various pathologies, among which:

• tuberculosis with severe damage to the organs of the respiratory system;
• hepatitis of a toxic nature caused by various chemicals, such as medicines or alcoholic beverages;
• brain damage;
• herpesvirus infection with damage to the skin and further spread to the organs of the respiratory, digestive and other body systems;
• epilepsy;
• swelling of the brain.

Against the background of HIV, various pathologies of a viral, fungal and bacterial nature often occur, which affect various organs and always proceed with complications.

The main consequence of HIV in pregnant women is the infection of the fetus inside the womb, during childbirth and lactation. Also, pregnancy on the background of HIV can occur with various complications. When taking antiviral drugs, the risk of infection of the baby is reduced several times.

Treatment

What can you do

If a pregnant woman feels unwell and has symptoms that are not related to pregnancy, she should see a doctor. In general, it is best to plan a pregnancy after testing for all types of possible infections. This will protect both the expectant mother and the child from various complications. When making a diagnosis of HIV, do not despair. The main thing is to follow the doctor's recommendations.

What does a doctor do

HIV is an incurable disease. Therapy against the virus is aimed at reducing its symptoms, as well as stopping the development of infection. There are modern drugs that must be taken throughout life. They prevent the reproduction of the virus in the human body and prevent further damage to the immune system. They can only be taken with the approval of an obstetrician-gynecologist. In any case, during pregnancy, it is the doctor who must decide what to do next for the expectant mother. Usually, in the early stages of bearing a baby, it is recommended to have an abortion in the presence of HIV infection in the body of a pregnant woman. Abortion is performed only after a series of additional examinations, as it can be dangerous for the patient.

Prevention

Primary prevention of HIV in a pregnant woman includes a fairly wide range of different activities. Among them:

• informing young people about the ways of infection and the dangers of HIV;
• lack of uncontrolled sexual relations;
• mandatory control over transfused blood and its components;
• compliance with all rules for the processing of medical instruments, the use of exclusively disposable syringes and systems.

Secondary prevention of the immunodeficiency virus is carried out, as a rule, in the conditions of specialized medical centers, where an HIV-positive expectant mother must be registered. If she has an infection, she is prescribed special antiviral drugs that reduce the risk of transmitting the pathology to the baby. Childbirth in infected mothers is carried out by caesarean section. They are also prohibited from breastfeeding the child. A pregnant woman with HIV should visit a gynecologist in the same way as absolutely healthy patients. That is, in the first trimester 1 time per month, in the second - 1 time in two weeks, and in the third - 1 time per week. The doctor decides on the need for additional examinations and visits.