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HIV Infection and pregnancy

HIV Infection and pregnancy

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The Human Immuno-deficiency Virus (HIV) is a germ (virus) which is spread from person to person during sexual intercourse, or through infected blood (for example, needle injuries to health professionals). Spread may be reduced by using condoms.

Monday, November 27th, 2017

A person who is infected may remain healthy for many years before developing the illness called Acquired Immune Deficiency Syndrome (AIDS).

At present AIDS is a fatal illness for which we do not have a cure. During the years when people become infected but remain healthy, they are unaware of the infection unless a blood test is done to show that they are HIV-positive. Despite being healthy, they may spread the infection to their sexual partners, and their babies.

Preconception decisions

Before deciding to fall pregnant, it is ideal for a woman to have an HIV test. If a woman tests HIV-positive, she should discuss the implications of this with a health professional. If she still desires to fall pregnant, her health, including HIV management, should be optimised before she tries to conceive.

A positive HIV test, means that the virus is present in the mother’s blood, and also in her breast milk.

If nothing is done to prevent it, about 30 out of every 100 mothers who are HIV- positive will spread the infection to their babies (during pregnancy and childbirth, or through breastfeeding). AIDS develops more rapidly in babies than in adults, and most infected babies die from AIDS during early childhood.

It is important that we do everything possible to reduce the number of babies infected with HIV

This requires many steps

  1. Follow the ABC of staying HIV-negative: Abstain Be faithful Use Condoms.
  2. Prospective mothers should ask about HIV testing before falling pregnant. If a mother tests positive, it is important for her health and HIV management to be optimised before trying to conceive. If a mother tests negative, it is important for her to take necessary precautions to prevent acquiring HIV infection during pregnancy and breastfeeding. Mothers, who contract HIV during this period, have a high chance of passing the infection on to their baby.
  3. Pregnant women should ask their health professionals about HIV testing, as it is only by knowing their HIV status that steps can be taken to reduce the chance of infecting their babies.
  4. All women who are not sure whether they or their partner may be infected with HIV or other sexually transmitted diseases should use condoms during pregnancy to prevent further infections.
  5. Women who are HIV-positive should always tell their caregivers this, so that steps can be taken to reduce the chance of infecting their babies.
  6. Treatment with ‘antiretroviral’ medicines reduces the chance of infecting the baby. Treating the mother throughout pregnancy with three antiretroviral medicines is expensive, but does reduce the risk of HIV infection to the baby to two out of 100 babies born to HIV-positive women. Treatment with one antiretroviral from 14 weeks gestation and two antiretroviral medicines during labour, as well as treating the baby after birth, is much less expensive and will reduce the incidence of infection during childbirth to less than five out of 100 babies born to HIV-positive women.
  7. During pregnancy, invasive procedures such as amniocentesis should be avoided whenever possible.
  8. During labour, artificial rupture of the membranes and internal foetal monitoring should be avoided.
  9. After birth, the baby’s face and mouth should be gently wiped free of any blood or secretions. Suctioning, which may cause trauma, should be avoided unless there is thick meconium or excessive mucus.
  10. In some hospitals, elective Caesarean section is used to further reduce the risk of infecting the baby.
  11. The baby should be tested for HIV using a PCR test, around 6 weeks after birth. If the baby shows signs of HIV infection before this time, the healthcare professional may decide to test the baby before 6 weeks of age. Before the birth, HIV-positive women should make a careful choice about feeding their babies. The recommendation is rather six months of full formula feeding, if adequate infant formula milk powder is available and affordable, before weaning the baby with complementary foods and a breast milk substitute. Cup feeding is preferred, especially if bottles and teats cannot be properly cleaned and sterilised. If safe and adequate formula feeding is not possible, or an unsuitable option, even the one in ten chance of spreading HIV to the baby through breastfeeding is better than the risks of unhygienic and inadequate bottle feeding. Breastfeed exclusively for six months then introduce solids and a breast milk substitute at six months. Continue feeds with breast milk substitutes, complementary feeding and enriched family foods, as advised by the health professional or registered dietician.

HIV infection is very difficult to cope with. It is vitally important to get help from a trained HIV counsellor.

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