Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome in Pregnancy

The human immunodeficiency virus (HIV) is the causative agent of acquired immunodeficiency syndrome (AIDS). Women infected with HIV first may demonstrate symptoms at the time of pregnancy or possibly develop life-threatening infections because normal pregnancy involves some suppression of the maternal immune system. HIV gradually destroys the body’s ability to fight infections and cancers thus a mother with AIDS is manage as high risk.

Being HIV positive puts you at a higher risk for complications such as preterm birth, intrauterine growth restrictions, and stillbirth. The risk of complications is higher for women with more advanced cases whose immune systems are compromised.

Many people have no symptoms when they first become infected with HIV. Others develop temporary flu like symptoms such as fever, headaches, sore throat, achiness, fatigue, and swollen glands in the first few weeks to months after being exposed to the virus.

It may take years after infection for more severe symptoms to develop these may include swollen glands, fatigue, weight loss, frequent fevers and sweating, persistent or frequent yeasts infections in your mouth or vagina, skin rashes, and even short term memories. It may take ten years or more to AIDS after being infected with HIV, even if your not being treated, or it may happen more quickly. But with appropriate and aggressive drug therapy, the prognosis is much better.

HIV can be transmitted through sexual exposure to genital secretions of an infected person (vaginal, oral, or anal sex), parenteral exposure to infected blood and tissue (sharing needles or even razors), or from perinatal exposure of an infant to an infected maternal secretions through birth or breastfeeding. HIV can also be transmitted through transfusion with infected blood.

Most people experience a gradual decline in the number of  CD4+ cells in their blood. These cells are the immune system’s key infection fighters. Healthy adults have 1,000 or more of these cells in every cubic meter of blood. Once you have fewer than 200 or develop one of 26 CONDITIONS, you are considered to have AIDS.

Testing for HIV is now recommended for pregnant women. Test to determine the presence of antibodies to HIV includes the enzyme-linked immunosorbent assay (ELISA), western blot, and immunoflorescence assay (IFA). A single reactive ELISA test by itself cannot be used to diagnose HIV and should be repeated with the same blood sample; if the result is again y, follow-up tests using western blot or IFA should be done. A positive Western blot or IFA is considered confirmatory for HIV. A positive ELISA that fails to be confirmed by western blot or IFA is not considered negative, and repeat testing should take place in 3 to 6 months.

Your practitioner will do blood tests throughout your pregnancy to test your viral load (the amount of virus in your blood), and CD4+ cell count. The results of these test will determine when to start drugs to suppress HIV ( this is called antiretroviral therapy), what type of therapy is best for you, and whether the regime your on is working or needs to be altered.

Your treatment will depend on your test results, your clinical condition, how far along your pregnancy is, and whether you’re already taking antiretroviral medications. Your caregiver will consider what’s known about any potential effects a medication may have on your baby. Deciding which drug to use to treat HIV infected people is especially complicated during pregnancy because there are two patients; the mother and her baby.

Zidovudine (ZDV) is recommended for the prevention of maternal-fetal HIV transmission and is administered orally beginning after 14 weeks gestation, intravenously during labor, and in form of syrup to the neonate for 6 weeks after birth. There are no medications that can eradicate HIV, but there are therapies that can help suppress so that your immune system functions better for a longer period of time and the onset of life threatening infections and cancers are delayed.

Pregnants with positive HIV should avoid procedures that increased the risk of perinatal transmission in prenatal period such as amniocentesis and fetal scalp sampling. As much as possible episiotomy should be avoided to decrease the amount of maternal blood in and around the birth canal, avoid the administration of oxytocin because contractions induced by oxytocin can be strong, causing vaginal tears or necessitating an episiotomy, placing heavy absorbent pads under the mother’s hip to absorb amniotic fluid and maternal blood, minimize the neonates exposure to maternal blood and body fluids, promptly remove the neonate from the mother’s blood following delivery, suctioning fluids from the neonate promptly.

Neonates born with HIV positive mothers may test positive because antibodies received from the mother may persist for as long as 18 months after birth; all neonates acquire maternal antibody to HIV infection, but not all acquire infection. The use of antiviral medications, reduction of neonate exposure to maternal blood and body fluids, and early identification of HIV in pregnancy reduced the risk of transmission to the neonate. Administer ZDV to the newborn infant as prescribed for the first 6 weeks of life. Note that HIV culture is recommended at 1 and 4 months after birth; infants at risk of HIV infection should be seen by the physician at birth, 1 week, 2 weeks, 1 month, 2 months, and 4 months of age. Infants at risk for HIV infection need to receive all recommended immunizations at the regular schedule; no live vaccines should be administered

Getting proper treatment can significantly reduce your risk of transmitting the virus to your baby and is crucial in protecting your own health if found to be positive for HIV. While it’s best for both you and your baby to begin treatment during pregnancy, late treatment is still better than nothing.