Is it possible to get pregnant if you are infected with HIV? HIV infection and pregnancy are the basic principles of having a healthy child. Impact of HIV on pregnancy

In the popular consciousness, the opinion is still firmly established that an HIV-infected woman should under no circumstances have children, so as not to doom him to suffering and early death. But scientists and doctors have been arguing for several years now that this is a deep misconception, and HIV-positive parents can have completely healthy offspring.

The World Health Organization has long published data that even in the complete absence of medical supervision, prevention and social support The risk of HIV transmission from mother to infant during formula feeding is 15-30%, and during breastfeeding it increases to 20-45%.

Transmission of HIV from mother to child can occur at three stages: during pregnancy, childbirth and breastfeeding. At each of these stages, the risk of transmission can be significantly reduced. If the mother takes special medications during pregnancy, special obstetric methods are used during childbirth, and breastfeeding is replaced by artificial feeding, then the risk of having an HIV-positive child will be only 2%.

“Unfortunately, many mothers abandon their children immediately after giving birth,” says Evgeniy Voronin, head physician of the Scientific and Practical Center for pregnant women and children with HIV infection, “although it takes a year and a half to understand whether the baby has the virus or not. The fact is that all children born to HIV-positive mothers have antibodies to HIV in their blood. They are produced in the mother's body and passed on to the unborn child.

Such antibodies create the impression that the child is infected. Maternal antibodies can remain in the child’s blood for a year and a half, after which they disappear, which means that the child is healthy, or the body begins to produce its own antibodies, which indicate that infection could not be avoided.

And it often turns out that HIV is not detected in a child, but he has been living in an orphanage for one and a half to two years, where, in general, few people are involved in his upbringing. As a result, such children lag behind their peers in their development and have difficulty communicating with people, which gives rise to a new set of problems.”

But let's return to how to help an HIV-positive mother give birth. healthy baby. Today, the GLOBUS project of the Global Fund to Fight AIDS, Tuberculosis and Malaria, within which the AIDS Foundation East-West (AFEW) operates, plays a significant role in the prevention of perinatal transmission of HIV infection.

Regional AIDS centers, obstetric and pediatric medical institutions and AIDS service associations take part in supporting HIV-positive parents before and after the birth of a child.

This support program includes pregnant women and women in labor who were admitted to maternity institutions with either a known HIV-positive status or an unknown one at the time of admission, who then underwent rapid testing for HIV with a positive result, regardless of whether they received chemoprophylaxis during pregnancy or not. As part of the project, HIV-positive women can be provided with emergency prophylaxis during childbirth, and their children can be provided with tuberculosis prophylaxis and infant formula.

Providing infants with formula for artificial feeding is one of the key problems in preventing infection of the child from the mother, which can occur during breastfeeding. As of 2005, in the Russian Federation, 3.9% of children born to HIV-positive mothers were breastfed from several days to several months.

In the regions where the GLOBUS project operates in 2005, per 100 children born to HIV-positive mothers, there were 5.6 cases of provision of infant formula as a preventive measure for vertical transmission of the virus from mother to infant. In 2007, this figure increased more than 10 times and amounted to 63.5 cases. From April 2007 to December 2007, 906 children born to HIV-positive women received formula milk. Over the entire period of implementation of the program, 1,876 HIV-positive children received infant formula.

And if at the beginning of the project the development of services for the prevention of HIV transmission from mother to child was carried out through 10 AIDS centers located in the regional centers of the constituent entities of the federation, then by December 2007, already 16 took part in the implementation of the program medical institutions(14 of them are AIDS centers), located, among other things, in regional centers. The expansion of the number of medical institutions providing a full package of preventive services has significantly increased the coverage of the project's target audience.

An equally important component of preventing the transmission of HIV from mother to child is information training medical workers antenatal clinics, maternity hospitals and pediatric clinics working with the category of HIV-positive pregnant women and mothers.

As part of the GLOBUS project, from September to December 2007, 17 information seminars on this topic were held for 320 medical workers from the above-mentioned medical institutions.

The training course includes the participation of specialists who guide an HIV-positive woman from the beginning of pregnancy to the completion of preventive measures for the newborn, and allows you to work out the mechanism of interaction between the main characters process: specialists antenatal clinic(gynecologist, obstetrician-gynecologist), infectious disease specialist at the AIDS center, maternity hospital specialists (obstetrician-gynecologist, neonatologist), local pediatrician and pediatrician at the AIDS center. Within two years, it is planned to cover about 1,350 more specialists of all categories involved in the system of preventing HIV transmission from mother to child.

The viruses currently identified with certainty, HIV 1 and HIV 2, are transmitted sexually, by blood, and from mother to child. In case of seropositivity, breastfeeding is contraindicated, as the virus can be transmitted through breast 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 common complication during pregnancy is infection of the baby (30-60% of cases). If HIV-infected future mom manages the pregnancy under the strict supervision of medical specialists, fulfills all necessary appointments, the risk of infection of the child is sharply reduced (up to 8%)!

Breastfeeding the baby is not allowed in this case.

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 that she is infected, she can take measures 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 of the disease or anamnestic data associated with the manifestations of the disease.

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

Folliculitis

HIV infection is accompanied by lesions hair follicles. The most characteristic of HIV infection is eosinophilic folliculitis, which essentially has diagnostic value. It manifests itself as itching, excoriation, follicular papules and pustules on the face, 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 color skin pigmentation remains after the inflammatory process has resolved.

Kaposi's sarcoma

Kaposi's sarcoma is usually seen in homosexual men, but can also occur in women, especially in areas where HIV infection is significant. Herpesvirus type 8 plays a significant role in the etiology of Kaposi's sarcoma. The tumor usually develops with advanced HIV infection, against the background of severe immunosuppression, but it is also possible early stage diseases. On the skin it appears as purple-brown spots, nodules or plaques. Kaposi's sarcoma can also develop in the oral cavity, and it can also affect the lungs with a poor prognosis. Histological examination allows you to confirm the diagnosis and differentiate Kaposi's sarcoma from 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 in the early stages of 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, in case of multiple genital warts, which are difficult to treat, and multifocal intraepithelial neoplasia of the cervix, HIV infection should be excluded. In severe immunodeficiency, the lesions are widespread.

Other diseases

Other diseases that are common in HIV-infected people include molluscum contagiosum, seborrheic dermatitis, ichthyosis, scabies and psoriasis. Relatively recently, cases of cryptococcosis and histoplasmosis have also become more frequently reported.

Transmission from mother to fetus

The HIV virus can be transmitted to the fetus from an infected mother late in pregnancy or during childbirth. With absence drug treatment the risk is 20 to 30% and varies depending on the stage of the disease. Offered various methods treatment to reduce the risk of fetal infection; they have proven to be effective, but do not completely eliminate the risk (3%).

After birth

A child born to an infected mother (a carrier of the virus) is always sero-positive, but is not necessarily a carrier of the virus itself. In fact, he receives all of his mother's antibodies, 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, from birth the child is subjected to tests (detection of the presence of a culture of the virus or its genome) to determine whether he was infected and, if necessary, to begin immediate antiviral treatment.

HIV and breastfeeding

The virus can be transmitted through breast milk, so breastfeeding is not recommended.

Prevention of HIV during pregnancy

The only way to combat the epidemic that this virus provokes is prevention (among other things, the use of condoms), since today there is no effective treatment, which would allow an infected person to be cured. Currently, doctors in our country can say with confidence that we are beginning an epidemic of the human immunodeficiency virus (HIV), which causes the disease AIDS. The picture is sad, since HIV now occurs not only among high-risk groups (homosexuals, drug addicts, prostitutes), but among fairly wealthy people from prosperous sections of the population. If at the beginning of the 1990s. the number of infected people and HIV carriers was represented mainly by the male population of the country, then in the modern 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 arises. AIDS is the terminal stage of a disease, in which a lot of other diseases arise from which a person dies; it is with AIDS that pregnancy and the ability to bear a full term developed child 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 attacks the human immune system, as a result of which 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. The person himself dies not from HIV, but from other diseases that the suppressed immune system cannot cope with. The HIV-1 virus is common among the population of the European and American continents, and HIV-2 is common among the African population. HIV is a rather complex virus that has special substances that allow it to penetrate the human body and settle in cells 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 only affects humans. The source of the disease is a sick person at any stage of the disease. Most often, the disease occurs during unprotected sexual intercourse, transfusion of blood components and donor blood, various medical procedures using instruments, organ transplantation, artificial insemination, intravenous injections, tattooing, manicure and pedicure, during which microdamage to the skin occurs and the virus penetrates through contaminated instruments, etc. Pregnant women with HIV infection can become infected with the child both internally (through the placenta) and during breastfeeding. Accordingly, pregnant women, as well as non-pregnant women, need to avoid the risk of infection in these settings. The most important things are hygiene of sexual relations and the presence of one partner. Women need to remember that the sexual partner is not obliged to tell the woman about HIV infection, since this is his personal right, and none of the doctors will tell you about his disease.

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 “foreigners” - macrophages that eat it. These cells carry it throughout the body and all organs. The virus leaves them and moves into lymphocytes (where it is most comfortable), here it lives and multiplies, having multiplied, it and its offspring penetrate into new cells, and the previous hosts die. Thus, 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 differently: in some cases, HIV turns into AIDS after 2-3 years, but there is also a slow variant (without treatment, life expectancy is ten to twelve years). In a normal human body, there are about 1000 cells of the immune system. In the first stages viral infection 800 cells remain, which is still enough to protect the body and the infection does not manifest itself: the person feels completely healthy. Then, during each year, another 50-60 cells die, and when their number is reduced to 300, the person begins to die from other diseases. It takes about 10 years until such a finale.

Currently, the following classification of stages of the disease is accepted in medicine: the period of penetration of the virus into the body (several months); period of primary manifestations: an infected woman may complain of a rise in temperature, which is not reduced by any medications, and the appearance of a quickly passing rash; a woman may notice an increase in lymph nodes, protruding in the form of peas under the lower jaw, in the armpits, etc.; stool disturbance (loose and frequent); stomach ache; frequent appearance of herpes on the lips or in other places. In short, there can be a variety of complaints, but women do not always pay attention to them Special attention and do not go to the doctor. This period lasts several weeks, then all phenomena disappear. Then comes the hidden, or latent, phase, when there are no manifestations of the disease; its duration depends on the rate of virus reproduction in the body and the death of immune system cells. The final stages 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 a fifth stage is also distinguished, when there are no more cells less than 50).

Clinic for 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 of HIV infection, but also of other diseases. Some women will complain of a slight increase in temperature, manifestations of sore throat, pain when swallowing, the appearance small rash, which quickly disappears. The woman herself can feel enlarged lymph nodes in her neck, armpits and other places. They are felt as round 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 include a decrease in body weight to 10 kg, which can please a woman. Women often suffer from ARVI, sore throat and other respiratory diseases. When the disease (untreated) slowly progresses to stage 4B, women begin to turn to many specialists regarding 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, and a feeling of dry hair.

Pyoderma is a disease manifested by the appearance large quantity pustules on the skin of the face and body. Despite the treatment, pustules appear again and again.

Candidiasis of the mucous membranes - caused by 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 fungal growth, copious discharge in the form of small crumbling cheesy masses, the separation of which reveals an inflamed surface. With vaginal candidiasis, women complain of pain during sexual intercourse and an unpleasant specific odor. Very often, in women at stage 4A of the disease, the herpes simplex virus is activated, which manifests itself in frequent rashes not only on the lips, but also on other parts of the body that were previously free from it. The herpes zoster virus, a member of the herpes virus family, is also activated. Herpes-like rashes appear along the branches of the nerve endings, accompanied by itching, burning, and pain. A woman loses weight over 10 kg. Whitish spots appear on the tongue, “shaggy” in appearance - “hairy” leukoplakia of the tongue develops. Very often women develop all sorts of fungal infections, for example, fungal infection of the nails of the hands and feet, skin of the feet and scalp. Characteristic for HIV infection and respiratory diseases: pneumonia, which is quite severe and difficult to treat. The final stages 4B and 5 are characterized by the development of opportunistic diseases (diseases that cannot develop in healthy people) caused by one’s own bacteria. Such infections include Pneumocystis pneumonia, Kaposi's sarcoma and other diseases, the development of which causes sick people to die. Disorders very characteristic of HIV infection nervous system: many have impaired skin sensitivity to various irritants, increased physical activity(hyperkinesis) of individual muscle groups or, conversely, a decrease or inhibition of muscle activity (paresis). The organ of vision may be affected, leading to blindness.

Kaposi's sarcoma is a malignant tumor of the blood vessels, usually of the arms, torso, or face. HIV infection poses a serious danger to pregnant women and their children. The time of infection of the mother is very important for diagnosing the possibility of bearing a fetus and its normal development. For example, if a woman became infected with HIV long before pregnancy (1-4 years), and she receives good treatment with the most modern drugs, then the opportunity to give birth healthy child hers is very big. This pregnancy must be planned, the mother of the child must not have bad habits, lead a healthy lifestyle and receive modern scheme treatment, then the probability of having a healthy and a 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 list and declared 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 the child may become infected. In such cases, the child is born apparently quite healthy, but already HIV-infected, or the pregnancy is terminated. If left untreated, pregnancy only worsens the woman’s condition, and the infection progresses rapidly. The woman herself can die quite quickly; 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 disease complex. For all expectant mothers, a healthy and correct image life, regular visits to antenatal clinics, the health of their babies depends on it. 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.

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 twice gives positive result, 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 further later and also after the birth of a 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;
• wrong intrauterine development fetus, in 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- upon reaching the maximum acceptable values infection there is a chance of HIV transmission during childbirth through amniotic fluid. In most cases, delivery in HIV-positive pregnant women occurs by caesarean 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 developing embryo is inserted 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, everything is far married couples 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 are 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 new life. However, every woman with HIV must be aware that she and her husband will have to go through a difficult long haul 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 you into the background. negative thoughts about your illness.

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

Symptoms

The first signs of HIV infection begin to appear after the end of incubation period diseases. That is, 2 weeks - six months or more after infection. Symptoms of HIV can appear once and go away even without additional treatment, and then remain silent for several years. In the acute phase of the pathology, the following signs appear in pregnant women:

• heat;
• enlarged lymph nodes;
• the appearance of a rash on different parts bodies;
• pain in 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 can 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, testing for the presence of HIV infection is mandatory. Typically, expectant mothers undergo a PCR test, which allows detection of the RNA virus at an early stage in the development of HIV. The doctor may also 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 necessary 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, including:

• tuberculosis with severe damage to the respiratory system;
• toxic hepatitis caused by various chemicals, for example, medications or alcoholic beverages;
• brain damage;
• herpes virus infection with lesions skin and further spread to the organs of the respiratory, digestive and other body systems;
• epilepsy;
• cerebral edema.

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

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

Treatment

What can you do

If a pregnant woman feels unwell and has symptoms not related to pregnancy, she should see a doctor. In general, it is best to plan a pregnancy after being tested for all types of possible infections. This will protect both the expectant mother and the child from various complications. When diagnosed with 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. Exist modern drugs, which must be taken throughout life. They prevent the virus from multiplying 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 the expectant mother should do next. Usually, in the early stages of pregnancy, it is recommended to have an abortion if there is HIV infection in the pregnant woman’s body. An abortion is carried out only after a number 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 measures. Among them:

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

Secondary prevention of the immunodeficiency virus is carried out, as a rule, in specialized medical centers, where an HIV-positive expectant mother must register. If she is diagnosed with an infection, she is prescribed special antiviral drugs that reduce the risk of transmitting the pathology to the baby. Infected mothers give birth by cesarean 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 once a month, in the second - once every two weeks, and in the third - once a week. The doctor decides about the need for additional examinations and visits.

HIV infection today, unfortunately, is a very common disease. As of November 1, 2014, the total number of HIV-infected registered Russians was 864,394 people, and in 2016 the epidemiological threshold was even exceeded in some cities. These include women of childbearing age who want and can fulfill their desire to have a child. With a carefully planned approach and coordinated work between the patient and doctors at several levels, it is possible to give birth to a healthy baby with minimal risk for your own health.

Research to find the most effective set of measures to prevent the transmission of the virus from mother to child has been conducted for many years. These studies began with the examination and treatment of HIV-infected women in Malaysia, Mozambique, Tanzania and Malawi, that is, those countries where the percentage of HIV-infected women of childbearing age reached 29% (!) of the total number of these women. The urgency of the problem was that in these and a number of other countries there was an extremely high level of maternal and child mortality. Further research was carried out in a number of European countries, and certain schemes for the management of pregnant women and preventive measures during childbirth were developed, which are now regulated in the standards of medical care.

HIV infection is a chronic infectious disease caused by two types of human immunodeficiency virus (HIV-1 and HIV-2). The essence of this infection is that the virus integrates into the immune cells (directly into the genetic material of the cell) of the body, damages and suppresses their work. Moreover, when the protective cells multiply, they reproduce copies that are also affected by the virus. As a result of all these processes, the body's immune defense is gradually destroyed.

HIV infection does not have any specific symptoms, it is dangerous for the development of opportunistic (concomitant) infections and malignant neoplasms. This occurs due to the fact that the body is not able to resist the invasion of pathogenic flora from the outside, the proliferation of pathogenic and opportunistic flora of its own body, and the body’s oncological defense is also reduced. Genetic breakdowns regularly occur in the body at the cellular level; normally, “wrong” cells are quickly destroyed and do not pose a danger, but with HIV infection, the number of killer cells (a special population of cells that recognize altered genetic material and destroy it) is significantly reduced. The body is defenseless not only against oncology, but also against a common cold. The extreme stage of HIV infection is acquired immunodeficiency syndrome (AIDS).

Source of HIV infection are people infected with HIV at any stage of the disease, including the incubation period.

Routes of transmission

1. Natural: contact (mainly sexual with any type of sexual contact) and vertical (from mother to fetus through blood).

2. Artificial:

Artificial non-medical (use of contaminated instruments for manicure, pedicure, piercing, tattooing; use of a shared syringe for intravenous drug administration);

Artificial medical (infection of the virus as a result of tissue and organ transplantation, transfusion of blood and plasma components, use of donor sperm).

Diagnosis of HIV during pregnancy:

1. Determination of antibodies to HIV by ELISA performed three times during pregnancy (at registration, at 30 weeks and at 36 weeks). If a positive result is obtained for the first time, then blotting is carried out.

HIV testing is always carried out with the consent of the patient; recently, some centers have allocated a quota for a one-time HIV test. father's HIV child.

First, pre-test counseling is carried out, an infectious and sexual history is collected, and the presence, nature and length of bad habits and intoxications are clarified. You should not be offended by your obstetrician-gynecologist for seemingly inappropriate questions about intravenous drugs and the number of sexual partners, about alcohol and smoking. All this data allows you to determine your risk level in obstetric terms, and we are not just talking about HIV infection. They will also tell you what HIV infection is, how it threatens a person, how it is transmitted and how to prevent infection, what the results can be and in what time frame. You may have read and are aware of the basics of this problem (we hope so), but listen to your doctor and you may have new questions to ask. Don't consider pre-test counseling a formality.

Post-test counseling is provided if the result is positive for HIV. All the same information is repeated as in pre-test counseling, because now this information is no longer informational, but practical. Then the impact of HIV infection on pregnancy, the risk of transmission to the fetus and how to minimize it, how to continue to live with such a disease, how to treat it and where to go in certain cases is explained in detail.

The patient should be consulted by an infectious disease specialist at the AIDS center (inpatient or outpatient, it depends on the obstetric situation) and registered. Without an account, it is impossible to obtain antiretroviral therapy drugs; they are provided at a discount, and few people can afford to buy them on their own. The price of drugs ranges from approximately 3,000 to 40,000 thousand rubles per drug, and, as a rule, the patient receives from two to five types of drugs.

2. Immune and line blotting is a highly sensitive research method to confirm or refute the diagnosis of HIV infection. This method is used if a questionable or positive result for HIV antibodies is received. In this case (if blood is taken for the second stage of the study), the result “HIV is delayed” is sent to the antenatal clinic.

3. Determination of immune status.

Immune status is the number of CD4+ T cells per cubic millimeter of blood. These are protective cells of the lymphocytic system, their number reflects the degree of damage to the immune system by the infection, the depth of the infectious process. Depending on the number of CD4+ T cells, the activity of antiretroviral therapy is selected.

U healthy person the number of CD4+ T cells is in the range of 600 – 1900 cells/ml of blood. Immediately after infection (1-3 weeks), the cell level may drop sharply (but we rarely see the patient at this stage), then the body begins to resist and the number of lymphocytes increases, but does not reach the original level. Thereafter, the level of CD4+ T cells gradually decreases by approximately 50 cells/ml per year. For a long time, the body can resist HIV infection on its own, but with the onset of pregnancy the situation changes, here the prescription of approved antiretroviral drugs is carried out to all women without exception.

4. Determination of viral load. Viral load reflects the number of copies of viral RNA (genetic basis) that circulates in the blood. The higher this indicator, the more dangerous the course of the disease, the faster the damage to the immune system and the higher the risk of transmission by any means. An indicator of less than 10 thousand copies in one μl is considered a low viral load, and more than 100 thousand copies/μl is considered high.

5. Express testing for HIV. This type of study is carried out if a woman enters maternity hospital unexamined, and there is no time to wait for the results of ELISA for HIV (an emergency situation requiring delivery). In such a situation, blood is taken for analysis using the ELISA method and rapid testing at the same time. A final diagnosis of HIV infection cannot be made based on the results of a rapid test. But a positive or questionable result of such an emergency analysis already serves as an indication for HIV chemoprophylaxis during childbirth and the prescription of antiretroviral prophylaxis to the child on the first day (syrup). Probable toxic effect chemotherapy is not comparable to the possible prevention of HIV transmission to a baby. Then, within 1 – 2 days, the ELISA result comes back, depending on the result, further examination and consultation with an infectious disease specialist at the AIDS center are carried out.

Planning a pregnancy with HIV

Realization of one’s reproductive function is the right of every woman, no matter how others view it. But in the case of HIV infection, a planned pregnancy is practically the only chance to give birth to a healthy baby and not transmit the virus to him. There are also families where only one of the spouses is infected. Next we will tell you how conception is carried out in these cases.

1. Both spouses are infected.

Complete examination of the couple for significant infections. Tests must be taken for hepatitis B and C, microreaction for syphilis, tests for STIs (gonorrhea, chlamydia, trichomoniasis, ureaplasma, mycoplasma), herpes viruses, cytomegalovirus and Epstein-Barr virus. All identified diseases should be treated as completely as possible, as this reduces the risk of intrauterine infection of the fetus.

General examination ( general tests blood and urine biochemical analysis blood, fluorography, consultations with specialists according to indications).

Consultation with an infectious disease specialist at the AIDS center and timely prescription of highly active antiretroviral therapy (HAART) to both partners. This is necessary to reduce the viral load and protect partners as much as possible, since they can be infected with early types of the virus. In addition, once the virus enters the human body, it inevitably mutates.

2. The wife is infected, the husband is healthy.

This situation is the “simplest” for doctors in terms of safe conception, since unprotected sexual intercourse is not required, but with great risks for the unborn child.

You should also conduct a general examination and specific tests for infections, and treat any identified infections.

A woman needs to consult an infectious disease specialist at the AIDS center; if she is not yet registered, then register, report her planned pregnancy and receive antiretroviral therapy drugs.

Most in a safe way conception is artificial insemination. This is a method in which during the period of ovulation (on days 12–15 menstrual cycle) a woman's vagina is artificially injected with her partner's sperm.

3. The husband is infected, the wife is healthy.

It is much easier for a woman to become infected with HIV through contact with an infected man than for a man under the same conditions. This happens because the contact of sperm and the vaginal mucosa is much longer than the contact of the skin and mucous membrane of the penis with vaginal secretions. For this reason natural conception in this situation is associated with high risk infection, and the more attempts, the higher the probability.

General examination and treatment are the same as in previous cases.

The preferred method of conception is the introduction of purified sperm into the woman's vagina on the days of ovulation. Few people know that sperm themselves cannot be infected with the immunodeficiency virus, but the seminal fluid surrounding them, on the contrary, carries a very high viral load. If you introduce purified sperm, then the risk of infection is minimal (the virus content during purification can be reduced by up to 95%). This method is preferable to couples with a specified infectious history.

In some cases, in vitro fertilization methods (IVF, ICSI) are used. As a rule, these methods are used if there is also a pathology of the partner’s sperm (azoospermia, asthenozoospermia, and others) or other forms of infertility.

Managing pregnancy with HIV

1. How does pregnancy affect HIV infection?

Pregnancy is a state of natural immunosuppression due to high level progestron (the hormone that maintains pregnancy). Some suppression of the immune system is necessary to ensure that the mother’s body does not reject the fetus’ body, since the child is an independent organism that half inherits the father’s genetic material, which means it is foreign.

In the absence of antiretroviral therapy, HIV can progress during pregnancy, moving from a latent stage to stages with complications, which threatens not only health, but also life.

When treatment is started in a timely manner, significant dynamics in the development of HIV infection are not observed. According to some data, after childbirth the state of immunity even improves, they don’t yet know how to explain this, but there is such data.

During pregnancy, a woman living with HIV is seen by two obstetricians and gynecologists. The obstetrician-gynecologist at the antenatal clinic carries out general management of pregnancy, prescribes examinations in accordance with Order No. 572 and treatment of obstetric pathology (threatened miscarriage, nausea and vomiting of pregnant women, preeclampsia and others).

An obstetrician-gynecologist at the AIDS center examines the patient at least three times during pregnancy. Here, an obstetric examination is combined with data on the immune status and viral load, based on the totality of examinations, management and treatment tactics are developed, it is possible to change antiretroviral therapy or add another drug to the regimen. At the last visit at 34–36 weeks, the patient is given not only a medical certificate, but also a drug for HIV chemoprophylaxis during childbirth ( intravenous administration), as well as a drug for chemoprophylaxis HIV for a child in the form of syrup. The woman is also given detailed diagram use of both forms of drugs.

2. How does HIV infection affect pregnancy?

Of course, first of all, we are interested in the risk of transmitting the virus to a child. Other pregnancy complications are rarely directly related to HIV infection. Infection does not directly affect the ability to become pregnant.

Without chemoprophylaxis for HIV infection, the risk of transmission of the virus from mother to fetus ranges from 10% to 50%. The virus can be transmitted in several ways:

1. Infection during pregnancy.
2. Infection during childbirth.
3. Infection during breastfeeding.

The percentage of types of infection in a child is presented in the figure.

There are many aspects and risks to this issue that determine the outcome of pregnancy with HIV.

Maternal aspects:

Viral load (the higher the viral load, the higher the risk of transmitting HIV to the child);

Immune status (the lower the number of CD4+ T cells, the less protected the mother’s body is and the higher the risk of any bacterial, viral and fungal complications, which cannot affect the child);

Concomitant diseases and bad habits.

All chronic diseases(especially inflammatory) reduce immunity to one degree or another. Your doctor is especially interested in the presence of hepatitis B and C (which is not uncommon in women who have injected drugs in the past or have had sexual contact with a drug user), STIs (syphilis, gonorrhea, chlamydia, trichomoniasis and others), as well as bad habits (alcohol, smoking, drugs and psychoactive substances in the past or this moment). Drugs pose a risk of direct intravenous infection with a number of infections, as well as the formation of severe complications, from infective endocarditis to sepsis. Alcohol is a significant factor in the development of immunodeficiency in itself, and in combination with existing HIV infection, it significantly worsens the prognosis.

Obstetric and gynecological aspects during pregnancy:

Sometimes there is a need for invasive diagnostics during pregnancy (amniocentesis - sampling amniotic fluid, cordocentesis - blood sampling from the umbilical vein), if for a healthy woman these measures take place with minimal risk (less than 1% spontaneous miscarriages and leaks amniotic fluid), then for an infected patient these manipulations can be dangerous, as the possibility of transmitting the virus to the child increases. If a situation arises where a geneticist (or ultrasound doctor) recommends invasive diagnostics, it is necessary to explain to the patient all the risks (possible birth of a fetus with a genetic syndrome and increased risk of infection), weigh and make an agreed decision. The final decision is always made by the patient.

Pathology of the placenta (chronic placental insufficiency, placentitis). In many pathologies of the placenta, one of its main functions, the barrier, suffers, thus creating the prerequisites for the virus to enter the baby’s bloodstream. The virus can also enter placental cells and multiply, and then infect the fetus.

During childbirth (for more details, see the article “Childbirth and the postpartum period with HIV infection”)

Premature opening of the membranes and rupture of water,
- rapid childbirth,
- prolonged labor and labor anomalies,
- birth injuries.

Risks from the child (more details in the article “Childbirth and the postpartum period with HIV infection”):

Large fruit
- prematurity and malnutrition of the fetus weighing less than 2500 grams,
- first child of twins,
- intrauterine infection fetus with skin lesions (pemphigus of the newborn, vesiculopustulosis),
- ingestion of amniotic fluid and aspiration (inhalation of amniotic fluid).

Chemoprevention of HIV transmission during pregnancy

For chemoprophylaxis of HIV transmission, drugs from the same series are used as for basic treatment. However, some drugs are contraindicated. They are not prescribed, and if a woman received them before pregnancy, they are replaced with approved ones. The list of recommended drugs is prescribed in the Order of the Government of the Russian Federation dated December 30, 2014 No. 2782-r.

Preparations:

1) HIV protease inhibitors (nelfinavir, atazanavir, ritonavir, darunavir, indinavir, lopinavir + ritonavir - this is a combination drug, fosamprenavir, saquinavir, telaprevir).

2) Nucleosides and nucleotides (telbivudine, abacavir, phosphazide, didanosine, zidovudine, stavudine, tenofovir, entecavir, lamivudine).

3) Non-nucleoside reverse transcriptase inhibitors (nevirapine, efavirenz, etravirine).

All these drugs are prescribed from 14 weeks (at earlier stages, the drugs may have a teratogenic effect, that is, provoking congenital deformities of the fetus). HAART (highly active antiretroviral therapy) medications are started even if HIV infection is detected several days before birth, since most cases of antenatal infection occur in III trimester. Prescribing treatment helps to significantly reduce the viral load almost immediately, which reduces the risk of transmitting the infection to the child. If HIV status has been known for a long time and the patient is taking therapy, then it should not be stopped (drug replacement is possible). In rare cases, during the first trimester, HAART medications are stopped (all at the same time).

Side and toxic effects of HAART drugs:

Effect on the blood system: anemia (decrease in hemoglobin and red blood cells), leukopenia (decrease in white blood cells), thrombocytopenia (decrease in blood clotting cells - platelets);

Dyspeptic symptoms (nausea, vomiting, heartburn, pain in the right hypochondrium and epigastrium, loss of appetite and constipation);

Hepatotoxicity (impaired liver function), detected when biochemical research blood (bilirubins, ALT, AST, alkaline phosphatase, GGT), in severe cases clinically (jaundice, itchy skin, lightening of stool, darkening of urine and other symptoms);

Impaired pancreatic function (pancreatitis), manifested by pain in the left hypochondrium or shingles, nausea, vomiting, fever, diarrhea and changes in tests (increased blood and urine amylase);

Osteoporosis and osteopenia (increased bone fragility) develop, as a rule, with long-term use;

Headaches, weakness, drowsiness;

Allergic reactions (usually urticaria).

Fetal risk of HAART:

The toxic effect on the hematopoietic system is the same as in the mother.

Children on HAART are generally born lighter than in the general population and gain weight more slowly in early life. Then the difference levels out and no significant differences in physical development are observed.

The influence of HAART drugs on the formation of the fetal nervous system was previously discussed, but at the moment it has been concluded that delayed psychomotor development and neurological symptoms are associated with maternal drug use. In the absence of a drug history, the indicators of psychomotor development of children from HIV-infected mothers on therapy and other children do not differ significantly.

The risks of HAART to the fetus are not comparable to the potential benefits of treatment.

After the start of chemoprophylaxis, the patient is monitored at the AIDS center, she is invited to consultative appearances to assess the effect of the drug, monitor compliance (adherence to treatment, adherence to the prescribed regimen), tolerability and severity of side effects. During the visit, a general examination, a survey of the patient and laboratory tests are performed (more about them below). After starting chemoprophylaxis, the first follow-up examination is performed after 2 weeks, and then every 4 weeks until delivery.

A CBC is given every time, since the most common side effect of HAART drugs (in particular azidothymidine) is a toxic effect on the hematopoietic system and the development of anemia, thrombocytopenia, granulocytopenia (decrease in the number of all blood cells).

The number of CD4+ T cells is assessed 4, 8, 12 weeks after the start of prophylaxis and 4 weeks before the expected date of delivery. If the number of CD4+ T cells is detected below 300 cells/ml, the chemoprophylaxis regimen is revised in favor of more active drugs.

The viral load is monitored after 4, 12 weeks from the start of therapy and 4 weeks before the expected birth. A viral load of 300,000 copies per ml also serves as an indication for intensifying therapy. A high viral load detected before birth serves as an additional indication for cesarean section.

Concomitant treatment

1. Taking multivitamin complexes for pregnant women (Elevit pronatal, Vitrum prenatal, Femibion ​​natalcare I and II).

2. Iron supplements for the development of anemia (sorbifer, maltofer and others).

3. Hepatoprotectors for signs of toxic liver damage (essential).

HIV infection in a woman of childbearing age is not a contraindication to pregnancy, but a serious and thoughtful approach is required. Perhaps there are not many pathologies in which almost everything depends on coordinated work patients and doctors. No one guarantees a woman with HIV the birth of a healthy child, but the more a woman is committed to therapy, the more likely she is to carry and give birth to an uninfected child. Pregnancy will be accompanied by taking a large number of different drugs, which is also risky for the fetus, but all this serves a good purpose - the birth of an uninfected baby. Take care of yourself and be healthy!