Stop mother to child HIV infection
A mother can minimize the risk of HIV transmission to her child by taking certain measures to prevent transmission of the virus after delivery.
What is the difference between HIV and AIDS?
HIV is the short form for Human Immunodeficiency Virus. Discovered in the early 1980s, it is commonly thought to have developed from a mutation of a virus found in monkeys. The virus is carried in the blood and destroys the blood cells which fight infections and diseases in the body. This results in severe deficiency in the body’s autoimmune system. After a period of time, typically between 18 months and several years, a syndrome or group of symptoms that are distinctive of the effects of HIV develop. This condition is called Acquired Immune Deficiency Syndrome or AIDS. AIDS is a condition which develops gradually out of infection by HIV. Full-blown AIDS results when HIV has matured and suppressed the body’s ability to fight opportunistic diseases.
What are the chances of a HIV-positive mother delivering a HIV-negative child?
The chances of a HIV-positive mother giving birth to a HIV-negative child are as high as 98% when there is medical intervention and 60 % when there is none.
What determines the level of risk of mother-to-child transmission?
The possibility of transmission depends on the kind of intervention prescribed during pregnancy and her general condition before conception. General condition reflects the level of concentration of HIV in her body.
There are certain periods when HIV in the blood is highly concentrated. Immediately after contracting the virus, it multiplies very fast in the body and if a woman conceives at this time, her chances of getting a HIV-negative child are low. At the onset of full-blown AIDS, the viral load is high increasing the chances of getting a HIV positive baby. In-between these two stages the body suppresses the virus and its concentration goes down. Babies conceived when the concentration is low have a higher chance of escaping HIV infection.
What precautions should a mother take to ensure she does not infect her baby?
The first thing is to visit a prenatal clinic. A drug called AZT is prescribed to be taken from the seventh month (28 weeks) to the onset of labor, when another drug called Nevirapine is introduced to the mother. These drugs lower the viral load. A mother is required to go for medical screening where a test is done to determine the number of white blood cells; these are responsible for fighting diseases in the body. The number of white blood cells is inversely proportional to the HIV load in the body. The lower the white blood cells, the higher the concentration of HIV in the body. Secondly, the pregnant woman should by all means avoid having unprotected sex to reduce the chances of re-infecting herself with HIV. Thirdly, she should stop harmful practices like smoking and consuming alcohol.
Should antiretroviral drugs be prescribed to HIV-positive mothers before 28 weeks?
Yes, to help prevent the spread of the virus and if the mother has full-blown AIDS or a low white cell blood count, that is CD4 levels less than 200/ml. CD4 cells fight infection and maintain the immunity of the body.
Do the drugs have any side effects on the unborn child?
In general, there are some antiretroviral drugs that are not supposed to be taken by pregnant women and most doctors are aware of this.
However, AZT and Nevirapine have no major known side effects on the child so far. It is still too early to appreciate the full scope of side effects since these drugs were introduced fairly recently.
Can a HIV-positive woman have a normal delivery?
Yes, one can have a normal delivery but precautions have to be taken on the techniques of delivery. During a normal delivery (referred to as ‘safe delivery’) for a HIV-positive mother, the midwife must ensure that no episiotomies are done and the umbilical cord is not milked (separating the blood in the cord before cutting it).
After delivery, is the mother given any special care?
Yes, the mother must be monitored and be put on triple antiretroviral therapy if her CD4 levels drop below 200/ml.
What care is the baby of a HIV-positive mother given after birth?
Soon after delivery or before 72 hours have elapsed since the baby’s birth, the baby is given antiretroviral drugs, Nevirapine or AZT, as a one-time post-exposure preventative treatment. The baby is subsequently put on septrine syrup once a day for 12 months. Septrine prevents opportunistic infections so that the baby’s condition does not turn into full-blown AIDS.
Can the HIV status of the baby be known immediately after birth?
One can know the baby’s HIV status immediately after birth by directly testing the viral load through a test known as a polymerase chain reaction (PCR). PCR is a very expensive test. The presence of HIV in the baby can also be determined through blood screening, which is conducted after 18 months. All babies born to HIV-positive mothers test positive before 18 months. This is because they inherit antibodies (specific substances which fight harmful bacteria) from their mothers. After 18 months the baby produces its own antibodies which replace the mother’s antibodies. If after 18 months the baby continues to have HIV-infected antibodies it means mother-to-child HIV transmission has already occurred.
Do HIV-positive mothers need special nutrition?
A HIV-positive mother and all mothers-to-be should eat a well-balanced diet that has a lot of proteins and vitamins, before and after delivery.
Can a mother breastfeed when she is HIV-positive?
In an ideal situation, one should not breastfeed. Breastfeeding greatly increases the chances of the baby getting the virus from the mother’s milk, especially if the mother is practicing mixed feeding (combining breastfeeding and extra foods). This is because the food the baby takes might cause some small wounds in the gut. This exposes the baby to the virus in the milk. A health provider must discuss with the mother the feeding options available. If it is necessary to breastfeed then one is encouraged to practice exclusive breastfeeding for four to six months, then switch abruptly to weaning (giving other foods).
END: PG 2/45