HIV, AIDS, Pregnancy

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HIV, AIDS, Pregnancy
HIV, AIDS, Pregnancy

Video: HIV, AIDS, Pregnancy

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Video: HIV / AIDS and Pregnancy - What You Need To Know 2023, January
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HIV / AIDS: pregnancy and breastfeeding

During pregnancy and while breastfeeding HIV-infected women are at increased risk of transmitting the virus to their child: Without any protective measures, 15 to 45 percent of children of HIV-positive mothers will be infected. This risk can be largely eliminated by taking appropriate medical measures and by not breastfeeding. It is therefore important that every pregnant woman is informed about her HIV status so that close care by specialized doctors during pregnancy as well as during and after the birth is guaranteed.

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  • more on the subject
  • Advice, downloads & tools
  • Adherence to therapy protects the child
  • Birth: by caesarean section or naturally?
  • After-birth care
  • Refraining from breastfeeding prevents HIV transmission
  • Follow-up care for children

The best way to do this is through the cooperation of an interdisciplinary center with a focus on HIV and a resident gynecologist.

Note The gynecologist will advise you and, with your express consent, can also carry out a search and confirmation test. In addition, she / he can provide you with the addresses and telephone numbers of other counseling facilities (e.g. women's groups in AIDS self-help groups, psychosocial counseling, etc.). If the test result is positive, a pediatrician should be consulted about the risk of transmission, check-ups and the course of the HIV infection in the child.

The following measures reduce the risk of HIV transmission to the (unborn) child:

  • during pregnancy: treating pregnant women with antiretroviral drugs.
  • Birth: Selection of the safest birth method for each individual (delivery by caesarean section or vaginal birth) and antiretroviral therapy for the newborn.
  • after childbirth: refrain from breastfeeding or feeding with your own breast milk.

Note In Austria, the Supreme Sanitary Council recommends that all pregnant women have HIV status. This is also provided for in the mother-child pass examination. In the mother-child pass it is only noted that an HIV test has been carried out. The test result is not given.

Adherence to therapy protects the child

In order to ensure adherence to therapy and the success of the treatment, the pregnant woman is informed about possible side effects of the antiretroviral therapy by her doctor. Other drugs that are taken in addition to HIV therapy can cause harmful interactions or jeopardize the success of the treatment. In order to avoid this, any additional medication intake should be discussed with the attending physician.

Birth: by caesarean section or naturally?

At birth, the method is usually chosen in which the probability of contact between the mother's body fluids containing viruses and the mucous membrane or skin of the child is as low as possible. Until recently, caesarean delivery was considered the safest way to prevent the transmission of viruses from mother to child. According to more recent studies, however, the protective effect of a caesarean section (Caesarean section) is at best minimal in women who receive ART during pregnancy and whose viral load towards the end of pregnancy is in a very low range (ideally below the detection limit).

A caesarean section has - regardless of an HIV infection - a higher risk of complications than a spontaneous birth in a natural way (vaginal birth). Vaginal delivery is therefore an option under the following conditions:

  • The pregnant woman is taking combination antiretroviral therapy.
  • The viral load is <50 copies / ml at the end of pregnancy, especially close to the delivery date.
  • The obstetric risks have been assessed by an experienced obstetrician.

HIV-infected pregnant women who do not meet these requirements should continue to give birth by caesarean section at the earliest from the 37th week of pregnancy. Due to the lower maternal complication rate (especially pneumonia, fever) and the early possible mother-child bond, a regional anesthetic method (especially spinal anesthesia) is recommended.

After-birth care

Both during a spontaneous delivery and a caesarean section, the amniotic fluid can be contaminated with HI viruses when the amniotic sac opens. In the case of spontaneous delivery, there is also the possibility that vaginal secretions containing viruses or maternal blood could enter the child's body orifices. In contrast to adults, the mucous membranes of the respiratory and digestive tracts do not represent any barriers for HIV in the newborn, and the not yet acidic (anacid) stomach can fail to inactivate the virus. The higher transmission rates of breastfed children from HIV-positive mothers prove that the oral intake of fluids containing virus is of considerable importance.

In order to minimize the baby's risk of infection, the following protective measures are routinely taken: After the birth, the baby is cleaned according to special hygiene standards. The newborn will then receive preventive antiretroviral therapy for a certain period of time, which is intended to prevent the virus from spreading in the event of a possible HIV transmission. As the child carries maternal antibodies in the first few months of life, an HIV test can be false positive at this point. Therefore, the detection of HIV-RNA in a child's blood is a safer detection method.

More information can be found here.

Refraining from breastfeeding prevents HIV transmission

Since HIV can be transmitted from mother to baby when breastfeeding, the World Health Organization (WHO) recommends that HIV-positive mothers not breastfeed. You can find more information (in English) on breastfeeding with HIV / AIDS on the website www.who.int.

Note Breast-feeding children of HIV-positive mothers are about twice as likely to be infected with HIV-1 as non-breast-feeding children of HIV-1-positive mothers. In western industrialized nations, HIV-positive mothers of newborns are therefore advised not to breastfeed.

In countries in which the exclusive feeding of infants with adapted baby food is not (socially) acceptable, feasible, affordable, safe (i.e. clean drinking water for hygienic preparation) or permanently available, the WHO recommends that infants of HIV-positive mothers be exclusively fed with breast milk a period of six months.

Follow-up care for children

From the 32nd week of pregnancy (SSW), IgG antibodies, including IgG antibodies against HIV, are transmitted from the mother to the unborn child. Since the common HIV test is an antibody test, all children of HIV-positive mothers, including non-HIV-infected children, are serologically HIV-positive until the maternal antibodies are eliminated.

The detection of HIV must therefore be carried out in the first year of life by detecting HIV nucleic acids using PCR. All positive HIV test results should be confirmed by a second blood sample as soon as possible. In children of HIV-positive mothers, two negative HIV-PCR results are necessary to rule out an HIV infection. The first negative HIV-PCR should take place after one month (after 28 days: sensitivity 96%, specificity 99%), the second, because of the 100% sensitivity and specificity of the HIV-PCR, after the third month of life.

With the HIV-PCR in the first month of life, almost all HIV-infected children are diagnosed. The recommended Pneumocystis jiroveci prophylaxis (start in the case of HIV transmission four to six weeks after birth if possible) and antiretroviral (early) therapy in the first months of life can then be carried out immediately.

Even with negative HIV-PCR results, the disappearance of maternal antibodies in children exposed to HIV should be documented at least once. Due to the intrauterine and postnatal (after birth) exposure of the child to antiretroviral substances, follow-up care of the children is essential in order to be able to record long-term damage. If a child is definitely diagnosed with HIV infection, antiretroviral therapy is initiated. The parents are specially instructed to ensure that the HIV therapy is taken as prescribed and that the treatment is successful.

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