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HIV in pregnancy is a serious issue that requires early intervention to guarantee the best possible outcomes for both the mother and the unborn child. To stop mother-to-child transmission, the condition needs to be carefully planned for, monitored, and treated (MTCT). Leading cosmetic gynecologist and PCOS specialist Dr. Shraddha Goel stresses the need of early detection and appropriate treatment in managing this illness. This manual offers a thorough examination of HIV during pregnancy, covering diagnosis, treatment, and prevention measures.

Understanding HIV and Its Impact on Pregnancy

What is HIV?

By targeting CD4 cells, which are vital for battling infections, the Human Immunodeficiency Virus (HIV) impairs immunity. Acquired Immunodeficiency Syndrome (AIDS), a potentially fatal illness characterized by a seriously weakened immune system, develops from HIV if therapy is not received.

How HIV Affects Pregnancy

HIV-positive women face unique obstacles during pregnancy, such as the possibility of virus transfer to the unborn child. This transfer may take place during:

1. Pregnancy through the placenta.
2. Exposure to the mother’s blood and fluids during labor and delivery.
3. Another risk of transmission is breastfeeding.

The Risk of Mother-to-Child Transmission

The risk of MTCT varies from 15% to 45% in the absence of any treatments. However, this risk can be decreased to less than 2% with the right care, which includes the use of antiretroviral therapy (ART) and suitable delivery techniques.

Diagnosis of HIV in Pregnancy

The Importance of Testing

One of the most important steps in preventing HIV transmission during pregnancy is universal screening. For high-risk populations, testing should preferably take place in the first trimester, with a follow-up test in the third trimester.

Testing Methods

1. Initial Screening:
   • HIV Antibody Test: Detects the antibodies the body makes against HIV.
   • Rapid HIV Test: provides outcomes in a matter of minutes, making it beneficial in prenatal settings.
2. Confirmatory Testing:
   • Western Blot Test: confirms HIV infection after an antibody test result that is positive.
   • HIV RNA or DNA Test: directly determines whether the virus is present.
3. Additional Tests:
   • CD4 Count: evaluates the health of the immune system.
   • Viral Load Testing: Determines the blood level of HIV, which is essential for controlling the virus during pregnancy.

Management of HIV During Pregnancy

Antiretroviral Therapy (ART)

The mainstay of HIV treatment during pregnancy is ART. When used regularly and appropriately, it helps reduce the viral load, lowering the risk of MTCT to almost zero.

• When to Start: Regardless of a woman’s CD4 level or viral load, ART should be started as soon as HIV is identified.
• Medications: To optimize efficacy and avoid drug resistance, a combination of antiretroviral medications is suggested.

Monitoring During Pregnancy

• Viral Load: Frequent testing guarantees that the infection won’t be detectable.
• CD4 Count: Monitored to assess the performance of the immune system.
• General Health Checks: Incorporate standard prenatal care, such as ultrasounds and checks for hypertension and gestational diabetes.

Preventing Opportunistic Infections

HIV-positive Pregnant women are particularly susceptible to fungal infections, toxoplasmosis, and tuberculosis. To protect mother and child, preventive care and vaccinations (such as the flu and Tdap) are crucial.

Delivery Planning for HIV-Positive Mothers

Choosing the Right Delivery Method

The mother’s viral load determines the delivery method:

• Viral Load ≤ 1,000 copies/mL: Vaginal delivery is suggested and safe.
• Viral Load > 1,000 copies/mL: To reduce the risk of MTCT, a planned cesarean delivery at 38 weeks is recommended.

Intrapartum Interventions

• Intravenous Zidovudine: If the viral load is detected, it is administered during childbirth to provide additional protection against transmission.

Postnatal Care for the Baby

Antiretroviral Prophylaxis for the Infant

To lower the chance of contracting HIV, newborns are started on antiretroviral therapy (ART) as soon as they are born.

• Low-Risk Cases: Zidovudine or other single-drug therapy for 4-6 weeks.
• High-Risk Cases: ART medication combo for the initial six weeks.

Infant Testing

• Early Diagnosis: At birth, 1-2 months, and 4-6 months, PCR testing are performed.
• Final Confirmation: The infant’s HIV-negative status is confirmed by two negative PCR tests, one of which is conducted six months later.

Breastfeeding Guidelines

• Formula feeding is recommended in environments with abundant resources to reduce the danger of transmission.
• Exclusive breastfeeding for the first six months is advised in environments with minimal resources, as long as the mother takes ART.

Preventing HIV in Future Pregnancies

For HIV-Negative Women with HIV-Positive Partners

1. Pre-Exposure Prophylaxis (PrEP): A prophylactic measure for individuals at elevated risk of HIV infection.
2. Consistent Condom Use: Stops sexual transmission.
3. Partner’s Viral Suppression: lowers the risk of transmission by ensuring the HIV-positive spouse stays undetectable.

For HIV-Positive Women

• Regular Monitoring: Ensures the virus’s continuous suppression.
• Family Planning Services: Helps in the safe pregnancy planning process.

Psychosocial Aspects of HIV in Pregnancy

Emotional Support

HIV-positive women may experience anxiety, dread, and stigma throughout pregnancy, making it a difficult time for them emotionally. Counseling services are essential for lowering stress and offering emotional support.

Support Groups

Women can get advice, exchange stories, and feel less alone by participating in support groups. These organizations promote empowerment and a feeling of community.

Addressing Stigma

It is crucial to make an effort to educate the public and lessen the stigma associated with HIV. Stigma could discourage women from getting prompt medical attention, putting both their own and their unborn child’s health at risk.

Research and Advances in HIV and Pregnancy

Pregnant mothers and their unborn children continue to benefit from advances in HIV research.

1. Newer ART Drugs: Along with to being safer during pregnancy, modern drugs are more effective and have fewer adverse effects.
2. Vaccines: HIV vaccine research shows potential for prevention in the future.
3. Gene Therapy: The goal of experimental methods is to completely remove HIV from the body.

Key Takeaways

1. Early Diagnosis is Crucial: Timely intervention is ensured by universal HIV screening during pregnancy.
2. ART Saves Lives: Regular ART use reduces the chance of transmission and protects the health of the mother.
3. Tailored Care Plans: It is essential to provide individualized care, which includes postnatal interventions and suitable delivery techniques.
4. Ongoing Support: The general wellbeing of moms living with HIV is improved by emotional and psychological care.

Conclusion

Despite its difficulties, HIV during pregnancy is treatable with the correct medical attention and assistance. Preventing transmission and guaranteeing the health of both mother and child depend on early diagnosis, ART adherence, and thorough prenatal and postnatal care. Dr. Shraddha Goel stresses the value of a patient-centered, holistic approach, equipping women with the information and tools they need to face their journey with optimism and confidence.