Give birth to a child of an HIV-infected man. Pregnancy with HIV infection

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 baby during artificial feeding is 15-30%, and with breastfeeding 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 to a 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 both with a known HIV-positive status and with an unknown one at the time of admission, who then underwent rapid testing for HIV with 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. According to 2005 data, in 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 regional centers subjects of the federation, then by December 2007, 16 medical institutions (14 of them were AIDS centers), located, among other things, in regional centers, took part in the implementation of the program. 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 players in the process: antenatal clinic specialists (gynecologist, obstetrician-gynecologist), infectious disease specialist at the AIDS center , maternity hospital specialists (obstetrician-gynecologist, neonatologist), local pediatrician and pediatrician at the AIDS center. Over the course of two years, it is planned to cover about 1,350 more specialists of all categories involved in the system of preventing the transmission of HIV from mother to child.

For many women, deciding to become pregnant is a real difficulty. She faces a difficult task, because she needs to think about whether she can risk her own health and the health of her unconceived unborn child. The desire to give birth is intertwined with fear and doubt if a man or woman is HIV positive.

Everyone understands perfectly well that HIV is a popular causative agent of AIDS. There are two types of HIV: HIV 1 and 2. HIV 1 is the most common, it is more insidious, because after it 35% of carriers develop AIDS. And for HIV 2 it is only 10%. The average time for AIDS to develop from the moment of infection is about 10 years.

Experts were able to isolate the infection from some fluids of the human body: tear fluid, saliva, urine, semen, blood. Today, infections are registered only through breast milk, sperm, and blood.

Conceiving a child

If a couple with the HIV virus wants to have a baby, they should consult a doctor and seriously think about it. This does not mean that all responsibility should be shifted to the doctor. His role is to conduct a consultation, and the man and woman, taking into account all the risks, make their own decisions.

Until today, it has not been proven that HIV during pregnancy affects health. Therefore, if certain conditions are met, pregnancy is still possible.

There is some difference if, at conception, the carrier of the infection is a woman or a man.

If a woman is infected with HIV:

Today in medicine there are various methods of conception, in which the transmission of infection to the fetus is significantly minimized. Unfortunately, no method provides a 100% guarantee that the child will not become infected.

If a man is HIV negative and a woman is infected, then the man is at risk of becoming infected when he conceives. To prevent this from happening, the expectant mother needs to use insemination. To do this, the man's sperm are collected in a sterile container and the woman is fertilized during a favorable period for conception, in other words, during ovulation.

If a man is infected with HIV:

Then there is a risk of infecting the woman. The baby will not be infected through sperm, but will become infected from the woman. To protect the wife, doctors recommend planning pregnancy in the most favorable days for fertilization, and also when the husband’s viral load is not determined.

There may be another option - cleaning sperm from the family fluid. Then the viral load decreases, and as a result the virus is not detected. Italian doctors performed this method on approximately 200 women, and none of them became carriers of the virus.

There is another method of artificial insemination, in which I use the sperm of another man to conceive.

If both spouses are infected with HIV:

Then the risk of infection of the baby is maximum. Also, during unprotected sexual intercourse, partners can become infected with various diseases.

Pregnancy

If a woman is infected and she is pregnant, then in this condition she should be under very strict medical supervision. If during pregnancy future mom stops using antiviral medications, there is a risk of rapid reinfection. And this increases the chances of vertical infection of the baby. In principle, even during pregnancy, the baby can become infected in the womb or during childbirth. There is evidence that infection from woman to baby occurs at the end of pregnancy. The risk of transmitting the virus to a baby from an infected woman is one in seven.

If the virus is first detected in a woman during pregnancy, she is told the truth about the possible risks and then given a personal choice: to plan a pregnancy or not. The pregnancy itself in an HIV-positive woman comes with some complications.

Childbirth period

During childbirth, there is a high risk of infecting the baby, because he is exposed to the vaginal sector and blood. Also, the risk of infection increases in the presence of various wounds and injuries that form as a result of surgical manipulations or the birth process.

If a pregnant woman is taking contraceptive medications, she is unlikely to be recommended for a cesarean section. And all because in her cases the chances of transmitting the infection to the baby are equal in both cases. Therefore, if therapy has not been carried out, then a cesarean section is chosen.

A woman is given the drug Zidovudine - this is a very useful prophylactic agent.

Postpartum period

If a child does not become infected with the virus during conception, pregnancy and childbirth, this does not mean that he will not become infected in the postpartum period. It has been proven that the virus is transmitted when a woman feeds her baby breast milk. Therefore, after giving birth, a woman is advised not to breastfeed her baby. Also, the mother is taught the rules of caring for the child so that she poses minimal risk to him. If a woman follows all precautions, the risk of infection will decrease many times.

What should you think about?

You need to think about whether you agree to pregnancy and agree to such a risk. You must understand: if a baby is infected in utero or during childbirth, in 80% of cases he will develop AIDS by the age of six. Will anyone raise a child if the parents are not doing well?

The decision regarding pregnancy is made only by the couple. And the doctor should support and help in every possible way.

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

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

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

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

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

Reducing the risk of HIV transmission during conception

To do this, both partners must contact an infectious disease specialist at the AIDS center and tell them that they are planning a pregnancy. An infectious disease specialist may suggest that the couple start taking special antiretroviral drugs. For a man - to reduce the viral load, for a woman - to reduce the risk of infection. After taking a course of pills, you can have unprotected sex, but it is better to do this as rarely as possible - on the days of ovulation. If pregnancy has occurred, the first thing you need to do is find out whether infection has occurred. HIV can be completely ruled out only after a “window” period of three months has passed. After this, you must use a condom every time you have sexual intercourse until the end of your pregnancy.

Sperm purification from HIV

Unfortunately, sperm purification from HIV is complex procedure, requiring special equipment that is not available in Russia. At the moment, sperm purification is carried out only in a few European countries, and it is not cheap.

Pregnancy due to HIV infection

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

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

Children born from HIV-infected mothers: clinical picture

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

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

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

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

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

Perinatal HIV: prevention

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

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

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

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

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

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

One more important point, which in no case should be forgotten, is that a child from an HIV-infected mother can become infected during lactation. Therefore, regardless of whether the baby is healthy or not, he should not be fed milk from the breast of a sick woman. You should immediately select (preferably in consultation with a doctor) adapted milk formulas. Children of HIV-infected parents should eat the same as their peers. In addition, it is recommended to introduce more vitamins and microelements into the diet, especially if the child is infected.

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

The following studies are required:

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

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

Children from HIV-infected fathers

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

The infected partner should do the following during pregnancy planning:

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

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

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

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

But the above procedure has several disadvantages:

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

If you follow all these measures, the risk of having an infected child is reduced to 2%. IVF is also possible. If 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 dissident movement is quite life-threatening - these are people who claim that the human immunodeficiency virus does not exist. This trend has claimed more than one adult and child’s life.

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

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