We all know what alarming developments the spread of HIV infection is taking in our time. The immune disorder that the virus causes often threatens the life of the infected person. And, unfortunately, the largest percentage of women infected with HIV are girls aged 18-30.

Since this is the most suitable age for the birth of a baby, many patients dream of leaving their mark on history and giving the world a new life. The only thing that stops expectant mothers is the risk of infecting the child. So, are pregnancy and HIV infection compatible, and can an infected mother give birth to a healthy child?

HIV is an abbreviation for Human Immunodeficiency Virus. The disease is transmitted exclusively through direct contact of the infected person with damaged tissues healthy person, as well as sexually.

That is, it is impossible to become infected with the virus through intact skin or through airborne droplets. It penetrates only through unprotected and vulnerable wounds and mucous membranes.

Virus and pregnancy

As statistics prove, HIV and pregnancy are not mutually exclusive. However, the sick mother needs to decide whether she is ready to risk her own health and the health of the baby. In this case, pregnancy is truly a huge risk.

The impact of the virus seriously changes the course of pregnancy and forces the mother to undergo examinations every 2 weeks or more often.

The birth of a child must be carried out with full responsibility. As a rule, HIV-positive women, for many reasons, begin to prepare for pregnancy many months before planned fertilization. And a false pregnancy literally opens the door to all pathogens.

Since in order to preserve the fetus, the woman’s body reduces its already damaged immunity, future mom must undergo a lot of tests, undergo antiretroviral therapy, and also contact a gynecologist and an AIDS center specialist in advance.

If an infected woman detects an unplanned pregnancy using an express test, it is necessary to urgently make a decision about cleaning or giving birth to a baby with a high chance of infecting him.

Another pitfall in the issue of having a baby for such women is a possible discrepancy between Rh and the blood type of the mother and fetus. Indeed, as a result of a strong difference, the woman’s body begins to produce antibodies that reject the fetus. I'm afraid that in the case of a serious Rh conflict, the problem can only be resolved by abortion.

Symptoms of conflict usually include:

• Bad feeling
• Nausea, vomiting
• Dizziness, loss of consciousness
• General painful condition
• Stomach ache

What are the dangers of pregnancy for a woman?

To ensure that the fetus is not rejected as a foreign body, the mother’s immunity itself is reduced to a certain level. It is clear that for HIV-positive women this bar will be much lower than for healthy women.

Reduced immunity seems to say: “Welcome!” all pathogenic microbes and bacteria in the environment. An ordinary cough, as if by magic, turns into pneumonia, and any scratch becomes a reason for panic.

Particular attention should be paid to such a delicate issue as hepatitis during pregnancy... Do you understand how serious this is? If an HIV-infected woman has hepatitis, then pregnancy becomes an unbearable burden and an unjustified risk.

Therefore, before deciding to bear a child, a woman must undergo full examination. Special blood test for infected women will help doctors see the viral load, the state of the immune system and general information about the functioning of the mother’s body. Only after receiving this data can doctors decide how safe the pregnancy will be.

Can an infected mother give birth to a healthy baby?

Yes, it certainly can. In the natural course of events, the child will become infected from the mother with a probability of 40-50%. Too much, right?

But with the help of doctors and properly selected therapy, as well as competent specialists managing pregnancy, the risk is reduced to 2 percent or less. Already a more acceptable probability, don’t you agree?

How can a child become infected?

1. During a normal pregnancy, the placenta prevents any infection from reaching the baby. However, if something goes wrong, infection can occur in the womb.
2. Also, when passing through the birth canal, the baby comes into close contact with the mother’s mucous membrane. Any damage (abrasions, ulcers) on the child’s body will greatly increase the risk of infection.
3. In addition, there is a high probability that the child will ingest vaginal secretions or mother’s blood. And through the esophagus and stomach the virus enters the baby’s blood.

Okay, but can infection occur without abrasions and ingestion? Unfortunately, the answer is yes. There is a huge chance that the virus will enter the child’s blood during a long period without water. What does it mean?

If the mother's water breaks, then 3 hours after this event the probability of infection is approximately 25%. Each subsequent hour increases the risk by an additional 10%.

Can a baby get the virus through breast milk? Yes, this possibility is also present. In the normal course of events, mother’s diseases do not get into the milk, but HIV infection makes the situation far from normal. Milk may contain some virus.

An additional risk factor is bleeding cracks in the nipples, which very often occur in wet nurses. Contact with the mother's blood will almost inevitably lead to infection of the newborn. Therefore, if there is any sign of damage breast-feeding stop.

To summarize, we can say that infection of an infant can occur:

• In the womb
• During childbirth
• During breastfeeding.

How to protect your child from the virus

1. Of course, specialist supervision is required. From the moment of pregnancy planning until the complete diagnosis of the child in postpartum period. Even if a woman finds out about an unplanned pregnancy, she must urgently contact a gynecologist and a specialist at the AIDS center. The doctor will prescribe antiretroviral therapy, which will help strengthen the immune system and reduce the risk of intrauterine infection of the fetus.
2. Most often, women diagnosed with AIDS are prescribed a planned cesarean section. This method of resolving labor minimizes the baby's contact with the mother's tissues.
3. Pregnant women with HIV infection are admitted to the prenatal department 2 weeks earlier than other women. Because premature departure amniotic fluid without emergency intervention, there is a risk of infection of the baby.
4. Artificial feeding. In such a complex and unreliable situation, you simply cannot rely on the body’s natural barriers. The risk of the virus entering the newborn’s body through cracks in the nipples is too great. Or due to a malfunction in the mother's defense mechanism. That's why artificial nutrition from the first days of life is more justified.

Problems conceiving in HIV-positive parents

In families where one or both partners are infected, sex is a difficult and controversial issue. Even if both are infected with the immunodeficiency virus, this does not remove restrictions on contacts.

The thing is that when HIV enters the human body, it changes.

sexual contact contributes to re-infection of both with an altered version of the virus.

If both partners are positive

Conception should occur under the supervision of specialists from the AIDS center. Each sexual intercourse greatly increases the risk of re-infection of the mother. Therefore, experts often suggest artificial insemination.

The sperm is collected, cleared of seminal fluid containing the virus, and then inserted into the woman’s vagina on the day of ovulation. Or the egg is also extracted, fertilized and implanted into the uterus.

If the mother is infected

When a man is HIV-negative, fertilization occurs on the day of ovulation using the father's semen, taken in advance, to prevent infecting the partner.

If the father is infected

In this case, either the sperm is cleaned from the seminal fluid and injected into the vagina on the day of ovulation, or donor material is used (sometimes even the seminal fluid of the father’s closest relatives is used).

In some cases, doctors allow the possibility of spouses having intercourse on the day of ovulation, but everything should happen under the strict guidance of specialists.

What care does the mother need during pregnancy?

I have already mentioned more than once that the immune system of a sick mother is overloaded during pregnancy. That is why she needs to take care of her health a thousand times more carefully than usual. Are there any rules for such mothers?

• Timely treatment and prevention of any possible health problems.

There is no place for even manifestations of thrush in the mother’s body.

• Refusal to visit public places.

A woman should, if possible, avoid any sources of infection. The subway, exhibitions, concerts are potentially dangerous places, and any sneeze towards a pregnant woman with AIDS can lead to a frozen pregnancy or worse.

• Minimizing Injuries

The pregnant woman should remain alone. Before the baby is born, there are no repairs, hikes, construction sites or other dangers.

• Purified water

Use raw water in such a situation is simply unacceptable! A pregnant woman can drink bottled or boiled water.

• Only proven products

No second hand purchases at markets, no untested country treats, etc. When a woman with HIV infection is carrying a child, she can only purchase literally sterile products in specialized stores.

As you can see, pregnancy for an HIV-infected woman is This is a big responsibility, but by no means a mistake. Nothing is impossible! The mother’s main goal is to strictly follow all the instructions of the specialists and take care of her health. Then any difficulty will be for nothing, efforts will bring good results, and the baby will be born healthy and strong.

In the matter of whether or not to give birth to a child, the last word always remains with the woman. This also applies to situations where the health of the unborn baby is threatened by HIV. Before deciding to take such a responsible step, you must carefully weigh the pros and cons, and be sure to consult a doctor. Information about the transmission of infection to a child and the possibilities of giving birth to a healthy child is constantly updated with new facts, so advice from a specialist will be completely useful.

A woman can be diagnosed with this after a blood test. This can be a real shock for a pregnant woman. A few years ago, a diagnosis of HIV meant surgery to terminate a pregnancy. It has now been proven that even an HIV-positive mother can give birth to absolutely healthy child. Medicine is constantly studying ways to reduce the risk of infection in a baby.

A pregnant woman who has received a diagnosis of HIV must decide the fate of her pregnancy in a short time. To do this, she must have as much information as possible about the disease. You can only get such information from a doctor; in these cases, it is better not to rely on the advice of friends and acquaintances. They may have false information about HIV disease and exert pressure, persuading them to immediately get rid of the child. All this can negatively affect the psychological state of the expectant mother.

Blood test for HIV during pregnancy

A blood test for HIV is mandatory for all pregnant women when they register with an antenatal clinic. It is advisable to donate blood for HIV during pregnancy in the first half of the day on an empty stomach. For analysis, about 5 mg of blood is taken from the cubital vein. The results of the analysis are confidential information, so the doctor can only communicate them to the patient in person. In addition to the hospital, there are special Centers prevention and control of AIDS, where you can donate blood for HIV infection anonymously, without indicating your data. There you can find out the result in 10-14 days by calling the number specified when taking the test. At AIDS centers you can get advice from specialists on HIV prevention and treatment.

Testing for HIV is very important, since the disease occurs without significant symptoms, with only slight swelling of the lymph nodes. An infected pregnant woman can, in most cases, pass the virus to her baby. And if she knows about her disease and takes treatment, the risk of infection of the baby can be minimized. Infection of a newborn can occur during childbirth through contact with blood or amniotic fluid, as well as during breastfeeding.

Therefore, preventive measures are provided; a woman is recommended to have surgery instead of childbirth. caesarean section, as well as artificial feeding of the baby.

False-positive HIV during pregnancy

Every woman planning to have a child should know that you cannot believe everything unconditionally. Even if a blood test for HIV during pregnancy is positive, you should not panic and think about diseases in all subsequent generations. To obtain accurate data, repeated blood tests for HIV are required. Therefore, in such a situation, the doctor will order you to take the test again. If a repeat test shows a negative result, the first test can be called a false positive. This phenomenon is not uncommon during pregnancy. Why does this happen?

1. Amazing processes take place in the body of a pregnant woman. Nascent new life consists of 2 genetic materials: maternal and paternal. Sometimes the mother’s body produces antibodies to protect against foreign DNA. It is this phenomenon that is recorded by the HIV test.
2. A false-positive HIV test may indicate chronic diseases in the body of the expectant mother.
3. Sadly, some people are irresponsible about their work, even laboratory assistants. Perhaps the tubes with blood were simply mixed up or similar names came across.

Pregnancy with HIV infection

Sometimes a married couple wants to have a child, already knowing that one or both partners are infected. Couples in which one partner is infected usually use a protective device during sex. To protect your second partner from the virus and to conceive a child, special techniques and recommendations have been developed.

Pregnancy and HIV: woman is HIV positive, man is HIV negative

In this case, partners practice only protected sex. The woman should go to the hospital for consultation. To exclude the possibility of infecting your partner, it is recommended to use a self-insemination kit. To do this, the partner’s sperm is collected in a special container, and on days favorable for conception, the woman independently uses the partner’s seminal fluid for fertilization.

Pregnancy and HIV: woman is HIV negative, man is HIV positive

In such a situation, there is a high risk of infection of the woman, as well as transmission of HIV infection to the unborn child through sperm. To reduce the risk of infection, partners use unprotected sex only on days favorable for conception. But this does not completely eliminate the risk of infection.

Currently, some well-known clinics offer newest way purification of sperm from HIV infection. This procedure is quite expensive, but it goes as follows. The seminal fluid undergoes a separation process in which live and dead sperm are separated. This material is preserved until time favorable conception in a woman. The fertilization procedure takes place in a clinical setting. Immediately before fertilization, the sperm is again tested for HIV infection. The disadvantage of this method is that it is only suitable for those men whose semen contains a large number of healthy, viable sperm.

In some cases, an HIV-negative woman is advised to undergo IVF with the sperm of an anonymous partner so that the couple has the opportunity to give birth to a healthy child. This method is used in cases male infertility and severe hereditary diseases in the man’s family.

Pregnancy and HIV: both partners are HIV positive

The main danger in this case is infection of the unborn child. There are also risks of transmission of treatment-resistant types of the virus from one partner to another. HIV-positive spouses must undergo a full examination and receive specialist advice in order to minimize the risk of infection of the baby.

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

If a woman knows that she is infected, she should not fear that pregnancy will worsen her condition. Complications can be caused by concomitant diseases, as well as bad habits. HIV infection does not affect intrauterine development fetus, its main danger is infection of the baby during birth.

HIV can be transmitted from a sick mother to her child in the following ways:

• in utero;
• during childbirth;
• when breastfeeding.

If an HIV-positive woman does not take any measures to protect her child from the virus, the risk of infection is about 30%. With timely preventive measures, it can be reduced to 2-3%.

Factors that increase a child's risk of infection:

• weakened immunity of a pregnant woman;
• high level of virus in the blood of an HIV-positive mother;
• breast-feeding;
• early discharge of amniotic fluid, bleeding;
• premature pregnancy;
• multiple pregnancy;
• taking drugs during pregnancy.

If the result for HIV during pregnancy was positive, but the woman decided to become a mother, how to give birth to a child without infecting him with the virus?

1. Follow all doctors' recommendations, undergo timely examinations, and regularly attend antenatal clinics.
2. Pregnant HIV-positive women are recommended treatment starting at 3 months of pregnancy. As a rule, drugs are prescribed that are safe for the baby. It is better not to refuse to take them; timely treatment begins reduces the risk of intrauterine infection of the fetus.
3. Proper nutrition, avoidance bad habits, healthy image life. All these are not empty words, they mean a lot to developing child. Baby gotta get maximum amount useful substances and dial required weight to resist infections.
4. Prevention of premature birth. Premature baby has low immunity, which increases the risk of infection.
5. Treatment of chronic diseases in the expectant mother.
6. Planning a caesarean section at 38 weeks. The final decision on the operation is made by the gynecologist, taking into account the condition of the pregnant woman.
7. Refusal of breastfeeding. The milk of an HIV-positive mother contains the virus, so adapted milk formulas are recommended for artificial feeding babies.
8. Prophylactic administration of antiviral drugs to newborns.

Every woman has the right to decide for herself how much she needs a child, even if he has a high risk of being born infected. The main thing is that this decision is thoughtful and balanced, and that the born child is desired and loved. Sometimes the birth of a child is an incentive for infected people to defend their rights and also monitor their health more carefully.

Symptoms and treatment of HIV infection. Video

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

The causative agent of the disease

HIV belongs to the Retrivi ridae family, subfamily Lentivirus. True to its name (Lentivirus is Latin for “slow” virus), HIV is in no hurry.

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

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

Symptoms of HIV

When HIV enters the human body, the immune system begins a long-term fight against the disease. For a long time Only special blood tests can determine the presence of HIV, as well as how successfully the body fights the virus.

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

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

Diagnostics

The only reliable method for diagnosing HIV infection is laboratory testing. During pregnancy, HIV blood tests are offered to all women three times during pregnancy. Tests cannot be prescribed forcibly without the patient’s consent. But you also need to understand that the sooner the correct diagnosis is made, the greater the patient’s chances of living. long life and give birth to a healthy child, even if you are a carrier of HIV. A doctor observing a pregnant woman must tell her about this, and he must also explain the benefits of timely diagnosis of HIV in pregnant women.

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

Polymerase chain reaction (PCR) allows you to directly determine the presence of the virus. Using PCR, the amount of free viruses circulating in the blood is determined. This amount is referred to as the “viral load.” Viral load shows how active the virus is in the blood. PCR, like ELISA, can give a false positive result. Therefore, when positive results are obtained, in addition to the listed methods, other diagnostic methods are used.

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

Course of pregnancy

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

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

Congenital HIV infection

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

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

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

Children born to HIV-positive mothers will also be HIV-positive immediately after birth. However, this does not mean that they are infected, since children are born with their mothers' antibodies. Maternal antibodies disappear from the baby's blood between 12 and 24 months. It is after this time that one can confidently judge whether the child has become infected. PCR diagnostics can help determine a child’s HIV status earlier. Already 4 weeks after birth, the reliability of PCR is 90%, and after 6 months - 99%.

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

Treatment during pregnancy

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

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

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

Prevention

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

1) HIV prevention among women of childbearing age;

2) prevention of unwanted pregnancies among women with HIV;

3) prevention of HIV transmission from mother to child.

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

HIV and AIDS

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

This is a chronic progressive infectious disease caused by a pathogen from the group of retroviruses and occurring before the conception of the child or during the gestational period. Long time proceeds latently. During the initial reaction, it is manifested by hyperthermia, skin rash, damage to the mucous membranes, transient enlargement of the lymph nodes, and diarrhea. Subsequently, generalized lymphadenopathy occurs, weight gradually decreases, and HIV-associated disorders develop. Diagnosed by laboratory methods (ELISA, PCR, cellular immunity study). Antiretroviral therapy is used to treat and prevent vertical transmission.

ICD-10

O98.7 B20-B24

General information

HIV infection is a strict anthroponosis with a parenteral, non-transmissible mechanism of infection from an infected person. Over the past 20 years, the number of newly diagnosed infected pregnant women has increased almost 600 times and exceeded 120 per 100 thousand examined. Most women of childbearing age became infected through sexual contact; the proportion of HIV-positive patients with drug addiction does not exceed 3%. Thanks to compliance with the rules of asepsis, sufficient antiseptic treatment of instruments for invasive procedures and effective serological control, it was possible to significantly reduce the incidence of infection as a result of occupational injuries, blood transfusions, due to the use of contaminated instruments and donor materials. In more than 15% of cases, it is not possible to reliably determine the source of the pathogen and the mechanism of infection. The relevance of special support for HIV-infected pregnant women is due to the high risk of infection of the fetus in the absence of adequate restraining treatment.

Causes

The causative agent of the disease is a human immunodeficiency retrovirus of one of two known types - HIV-1 (HIV-1) or HIV-2 (HIV-2), represented by many subtypes. Typically, infection occurs before the onset of pregnancy, less often - at the time or after the conception of a child, during gestation, childbirth, and the postpartum period. The most common route of transmission of an infectious agent in pregnant women is natural (sexual) through the secretions of the mucous membranes of an infected partner. Infection is possible through intravenous administration of narcotic drugs, violation of aseptic and antiseptic standards during invasive procedures, and performance of professional duties with the possibility of contact with the blood of the carrier or patient (health workers, paramedics, cosmetologists). During pregnancy, the role of some artificial routes of parenteral infection increases, and they themselves acquire certain specifics:

• Blood transfusion infection. With complicated pregnancy, childbirth and the postpartum period, the likelihood of blood loss increases. Treatment regimens for the most severe bleeding involve the administration of donor blood and drugs derived from it (plasma, red blood cells). HIV infection is possible when using material tested for the virus from an infected donor if blood is collected during the so-called seronegative incubation window, which lasts from 1 week to 3-5 months from the moment the virus enters the body.
• Instrumental contamination. Pregnant patients are more likely than non-pregnant patients to undergo invasive diagnostic and therapeutic procedures. To exclude fetal developmental anomalies, amnioscopy, amniocentesis, chorionic villus biopsy, cordocentesis, and placentocentesis are used. For diagnostic purposes, endoscopic examinations (laparoscopy) are performed, and for therapeutic purposes, suturing of the cervix, fetoscopic and fetal drainage operations are performed. Infection through contaminated instruments is possible during childbirth (when suturing injuries) and during caesarean section.
• Transplantation route of transmission of the virus. Possible solutions for couples planning a pregnancy with severe forms of male infertility are insemination with donor sperm or its use for IVF. As with blood transfusions, there is a risk of infection in such situations when using infected material obtained during the seronegative period. Therefore, for preventive purposes, it is recommended to use sperm from donors who have successfully passed an HIV test six months after donating the material.

Pathogenesis

The spread of HIV throughout the body occurs through the blood and macrophages, into which the pathogen initially penetrates. The virus has a high tropism for target cells, the membranes of which contain the specific protein receptor CD4 - T-lymphocytes, dendritic lymphocytes, some monocytes and B-lymphocytes, resident microphages, eosinophils, bone marrow cells, nervous system, intestines, muscles, vascular endothelium, choriontrophoblast of the placenta, possibly sperm. After replication, a new generation of the pathogen leaves the infected cell, destroying it.

Immunodeficiency viruses have the greatest cytotoxic effect on type I T4 lymphocytes, which leads to depletion of the cell population and disruption of immune homeostasis. A progressive decrease in immunity worsens the protective characteristics of the skin and mucous membranes, reduces the effectiveness of inflammatory reactions to the penetration of infectious agents. As a result, in the final stages of the disease, the patient develops opportunistic infections caused by viruses, bacteria, fungi, helminths, protozoal flora, typical AIDS tumors (non-Hodgkin's lymphoma, Kaposi's sarcoma) arise, and autoimmune processes begin, ultimately leading to the death of the patient.

Classification

Domestic virologists use in their work the systematization of the stages of HIV infection proposed by V. Pokrovsky. It is based on the criteria of seropositivity, severity of symptoms, and the presence of complications. The proposed classification reflects the step-by-step development of the infection from the moment of infection to the final clinical outcome:

• Incubation stage. HIV is present in the human body, its active replication occurs, but antibodies are not detected, and there are no signs of an acute infectious process. The duration of seronegative incubation usually ranges from 3 to 12 weeks, while the patient is infectious.
• Early HIV infection. The body's primary inflammatory response to the spread of the pathogen lasts from 5 to 44 days (in half of the patients - 1-2 weeks). In 10-50% of cases, the infection immediately takes the form of asymptomatic carriage, which is considered a more prognostically favorable sign.
• Stage of subclinical manifestations. Viral replication and destruction of CD4 cells lead to a gradual increase in immunodeficiency. A characteristic manifestation generalized lymphadenopathy becomes. The latent period of HIV infection lasts from 2 to 20 years or more (on average 6-7 years).
• Stage of secondary pathology. Depletion of protective forces is manifested by secondary (opportunistic) infections and oncopathology. The most common AIDS-indicating diseases in Russia are tuberculosis, cytomegalovirus and candidiasis infections, Pneumocystis pneumonia, toxoplasmosis, and Kaposi's sarcoma.
• Terminal stage. Against the background of severe immunodeficiency, severe cachexia is observed, there is no effect from the therapy used, and the course of secondary diseases becomes irreversible. The duration of the final stage of HIV infection before the death of the patient is usually no more than several months.

Practicing obstetricians and gynecologists often have to provide specialized care to pregnant women in the incubation period, at an early stage of HIV infection or its subclinical stage, and less often when secondary disorders appear. Understanding the characteristics of the disease at each stage allows you to choose the optimal pregnancy management regimen and the most suitable way delivery.

Symptoms of HIV in pregnant women

Since during pregnancy most patients develop stages I-III of the disease, pathological clinical signs are absent or appear nonspecific. During the first three months after infection, 50-90% of infected people experience an early acute immune reaction, which is manifested by weakness, a slight increase in temperature, urticarial, petechial, papular rash, inflammation of the mucous membranes of the nasopharynx and vagina. Some pregnant women have enlarged lymph nodes and develop diarrhea. With a significant decrease in immunity, short-term, mild candidiasis, herpetic infection, and other intercurrent diseases may occur.

If HIV infection occurred before pregnancy and the infection developed to the stage of latent subclinical manifestations, the only sign of the infectious process is persistent generalized lymphadenopathy. A pregnant woman has at least two lymph nodes with a diameter of 1.0 cm, located in two or more groups that are not interconnected. When palpated, the affected lymph nodes are elastic, painless, not connected to the surrounding tissues, the skin over them has an unchanged appearance. The enlargement of nodes persists for 3 months or more. Symptoms of secondary pathology associated with HIV infection are rarely detected in pregnant women.

Complications

The most serious consequence of pregnancy in an HIV-infected woman is perinatal (vertical) infection of the fetus. Without adequate containment therapy, the likelihood of a child becoming infected reaches 30-60%. In 25-30% of cases, the immunodeficiency virus passes from mother to child through the placenta, in 70-75% - during childbirth when passing through an infected birth canal, in 5-20% - through breast milk. HIV infection in 80% of perinatally infected children develops rapidly, and AIDS symptoms appear within 5 years. Most characteristic features diseases are malnutrition, persistent diarrhea, lymphadenopathy, hepatosplenomegaly, developmental delay.

Intrauterine infection often leads to damage to the nervous system - diffuse encephalopathy, microcephaly, cerebellar atrophy, and deposition of intracranial calcifications. The likelihood of perinatal infection increases with acute manifestations of HIV infection with high viremia, a significant deficiency of T-helper cells, extragenital diseases of the mother (diabetes mellitus, cardiopathology, kidney disease), the presence of sexually transmitted infections in a pregnant woman, and chorioamnionitis. According to the observations of specialists in the field of obstetrics, patients infected with HIV are more likely to experience the threat of miscarriage, spontaneous miscarriages, premature births, and perinatal mortality increases.

Diagnostics

Taking into account the potential danger of the patient's HIV status for the unborn child and medical personnel, a test for the immunodeficiency virus is included in the list of recommended routine examinations during pregnancy. The main objectives of the diagnostic stage are to identify possible infection and determine the stage of the disease, the nature of its course, and prognosis. To make a diagnosis, the most informative laboratory research methods are:

• Linked immunosorbent assay. Used as a screening. Allows you to detect antibodies to the human immunodeficiency virus in the blood serum of a pregnant woman. In the seronegative period it is negative. It is considered a preliminary diagnostic method and requires confirmation of the specificity of the results.
• Immune blotting. The method is a type of ELISA; it makes it possible to determine in serum antibodies to certain antigenic components of the pathogen, distributed by molecular weight by phoresis. It is a positive immunoblot result that serves as a reliable sign of the presence of HIV infection in a pregnant woman.
• PCR diagnostics. Polymerase chain reaction is considered a method for early detection of the pathogen with a period of infection of 11-15 days. With its help, viral particles are detected in the patient’s serum. The reliability of the method reaches 80%. Its advantage is the ability to quantitatively control HIV RNA copies in the blood.
• Study of the main lymphocyte subpopulations. The probable development of immunosuppression is indicated by a decrease in the level of CD4 lymphocytes (T-helper cells) to 500/μl or less. The immunoregulatory index, which reflects the ratio between T-helpers and T-suppressors (CD8 lymphocytes), is less than 1.8.

When a previously unexamined pregnant woman from marginalized populations is admitted for childbirth, it is possible to conduct a rapid HIV test using highly sensitive immunochromatographic test systems. For routine instrumental examination of an infected patient, non-invasive diagnostic methods are preferred (transabdominal ultrasound, Dopplerography of uteroplacental blood flow, cardiotocography). Differential diagnosis at the stage of early reaction is carried out with ARVI, infectious mononucleosis, diphtheria, rubella, and other acute infections. If generalized lymphadenopathy is detected, it is necessary to exclude hyperthyroidism, brucellosis, viral hepatitis, syphilis, tularemia, amyloidosis, lupus erythematosus, rheumatoid arthritis, lymphoma, and other systemic and oncological diseases. According to indications, the patient is consulted by an infectious disease specialist, dermatologist, oncologist, endocrinologist, rheumatologist, hematologist.

Treatment of HIV infection in pregnant women

The main objectives of pregnancy management during infection with the human immunodeficiency virus are suppression of infection, correction of clinical manifestations, and prevention of infection of the child. Depending on the severity of symptoms and stage of the disease, massive polytropic therapy with antiretroviral drugs is prescribed - nucleoside and non-nucleoside reverse transcriptase inhibitors, protease inhibitors, integrase inhibitors. Recommended treatment regimens vary depending on different dates gestation:

• When planning a pregnancy. To avoid embryotoxic effects, women with HIV-positive status should stop taking special medications before the onset of a fertile ovulatory cycle. In this case, it is possible to completely eliminate the teratogenic effect in the early stages of embryogenesis.
• Up to 13 weeks of pregnancy. Antiretroviral drugs are used in the presence of secondary diseases, a viral load exceeding 100 thousand RNA copies/ml, and a decrease in the concentration of T-helper cells less than 100/μl. In other cases, it is recommended to stop pharmacotherapy to exclude negative influences for the fruit
• From 13 to 28 weeks. When HIV infection is diagnosed in the second trimester or an infected patient presents at this time, active retroviral therapy is urgently prescribed with a combination of three drugs - two nucleoside reverse transcriptase inhibitors and one drug from other groups.
• From 28 weeks until birth. Antiretroviral treatment continues, and chemoprophylaxis for transmission of the virus from woman to child is carried out. The most popular regimen is in which the pregnant woman constantly takes zidovudine from the beginning of the 28th week, and nevirapine once before giving birth. In some cases, backup schemes are used.

The preferred method of delivery for a pregnant woman diagnosed with HIV infection is natural birth. When performing them, it is necessary to exclude any manipulations that violate the integrity of tissues - amniotomy, episiotomy, application of obstetric forceps, use of a vacuum extractor. Due to a significant increase in the risk of infection of the child, the use of drugs that induce and enhance labor is prohibited. Caesarean section is performed after 38 weeks of gestation when the viral load is unknown, its level is more than 1,000 copies/ml, there is no prenatal antiretroviral therapy and the impossibility of administering retrovir during labor. In the postpartum period, the patient continues to take recommended antiviral drugs. Since breastfeeding is prohibited, lactation is suppressed with medication.

Prognosis and prevention

Adequate prevention of HIV transmission from a pregnant woman to her fetus can reduce the rate of perinatal infection to 8% or less. In economically developed countries this figure does not exceed 1-2%. Primary prevention of infection involves the use of barrier contraceptives, sex life with a permanent trusted partner, refusal to use injecting drugs, use of sterile instruments when performing invasive procedures, careful monitoring of donor materials. To prevent infection of the fetus, it is important to timely register an HIV-infected pregnant woman with antenatal clinic, refusal of invasive prenatal diagnostics, choice of the optimal antiretroviral treatment regimen and method of delivery, prohibition of breastfeeding.

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 incubation period of the disease has ended. 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. There are modern medications that 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 on early stages When carrying a baby, 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 various events. 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 immunodeficiency virus is carried out, as a rule, in specialized settings. medical centers, where an HIV-positive expectant mother must register. If she is diagnosed with an infection, she is prescribed special antiviral drugs, which reduce the risk of transmitting 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.

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