Transmission of HIV from mother to fetus

- is not simply one of the major health problems today, but also a big problem in the field of human rights. People learned about their infection with HIV are at a double burden of stigma and discrimination. Fear of stigma and discrimination due to fear of HIV infection, and this creates great obstacles in the prevention of HIV and providing treatment, care and support to HIV-infected people and their families.

Research (Piwoz and Ross), conducted in 2002, provided information on vertical transmission of HIV infection in the absence of PVP interventions and breastfeeding for two years.

Following results were obtained on the number of infected children born to 100 HIV-positive mothers: 7 children can be infected in utero. 15 children can be infected during childbirth. 15 children can be infected within two years of breastfeeding. But the 63 children may not be infected, despite the absence of specific medical interventions, antiretroviral therapy and breastfeeding up to two years of age.

MOTHER WITH HIV There are no typical signs or differences, which could have been diagnosed with HIV at birth, clinical signs of HIV may occur in a child about 6 weeks of life, but up to months of age with HIV can not be confirmed by the determination of antibodies.

Key interventions for HIV in the obstetric hospital 1. Assessment of HIV status of mother, if he do not know, do a rapid test for HIV aftercounseling 2. The choice of method of delivery 3. We recommend elective cesarean section 4. Safe practices of childbirth 5. The use of ARVs during labor / cesarean 6. Safe infant feeding practices 7. Specialized care for newborns of HIV- positive mothers 8. Prevention of obstetric complications 9. Good advice in the postpartum period

 All women during antenatal visits to the antenatal clinic to be held advising on HIV testing. Giving women the quality of pre-and post-test counseling for HIV, regardless of HIV status of women, helps to prevent vertical transmission of infection and the spread of HIV among women and their sexual partners.

The first measure, carried out on admission of women in the maternity ward - an assessment of her HIV status.  If the HIV status of women is not known, the maternity hospital staff to conduct a proper pre- and post-test counseling for HIV and encourage woman to get rapid HIV testing.  Rapid HIV tests should be conducted only after the woman to the maternity hospital and with her consent.  Maternity ward staff should be skilled in counseling and testing, and the hospital should be available rapid tests for HIV.

The choice of mode of delivery, if the woman's HIV status is unknown at admission It is recommended that delivery by elective Caesarean section after 38 weeks of gestation. This is a time limit due to the need to strike a balance between the risk of respiratory distress in the newborn and the risk of perinatal HIV transmission during birth vaginally. The effectiveness of cesarean section for above, if it takes place before rupture of membranes and onset of labor. If the progress of labor has gone too far (the active fight, or was more than 4 hours after rupture of membranes), "elective" cesarean section can not be done, because in these circumstances, it does not have a significant impact on the risk of HIV transmission from mother to child.

The choice of mode of delivery should be based on an assessment of potential risks and benefits and with the informed consent of the woman.

We should also take into account the risk factors for intrauterine transmission of HIV: Inflammatory diseases of the pelvic organs severity of HIV infection in the mother A high viral load

GENERAL CARE AND TREATMENT When caring for a child from an HIV-positive mother, always: - Respect the privacy of mothers and families - Provide child care in the same manner as for any other, paying special attention to measures to prevent transmission of infection - Spend a child routine immunization in full - Please note the mother that her partner (s) must use a condom during sexual intercourse to prevent HIV and other sexually transmitted infections. - Provide emotional support

ANTIRETROVIRAL THERAPY  Without antiretroviral therapy, 15% to 30% of infants born to HIV positive mothers are infected during pregnancy and childbirth, and 5% -20% of infants are infected through breast milk.

antiretroviral treatment Long-term use of ARVs to treat HIV in the mother, as well as to the PVP HIV infection. Antiretroviral treatment is applied during pregnancy can improve maternal and reduce the risk of HIV transmission by reducing the child to the viral load in the mother. Receiving ARV is effective for treatment of HIV infection in the mother, and for PVP. Several modes of taking antiretroviral therapy reduces the risk of vertical transmission of HIV to children and lactating women. Mechanisms to ensure that the decreasing the risk of infection with the baby, including inhibition of virus replication in the mother, leading to a decrease in viral load in the child, during and after exposure to the virus.

Appointment of antiretroviral drugs Two schemes: *Prophylactic short course: to reduce the likelihood of vertical transmission of HIV - Zidovudine (ZDV) from weeks of pregnancy (or as soon as possible after detection of HIV in the later stages of pregnancy) until delivery (basic mode WHO) * Life Course: the treatment of HIV / AIDS in the mother - All women with AIDS - HIV-positive women (stage I and II according to WHO classification, if a CD4 less than 350 x 106 cells / l)

Safe infant feeding practices Human immunodeficiency virus is present in breast milk of HIV-positive mothers, and therefore can be transmitted to children in the process of breastfeeding. The risk of HIV transmission increases with increasing duration of breastfeeding by 5-10% during breast-feeding up to two years of age. The risk of infection through breast-feeding infants up to 20%, compared to artificial feeding.

Influence of infant feeding on the risk of HIV transmission: To achieve an infant 6 months of age there is no difference in the risk of HIV transmission through breast-or bottle-fed. The greatest risk is with mixed feeding. With increasing duration of breastfeeding risk of HIV transmission increases.

It is estimated that breastfeeding can become infected with approximately 15% of infants born to HIV-positive women. Thus, even in areas with relatively high HIV prevalence is 20% in a sample of 100 mothers and infants, only 2 or 3 are at risk of HIV infection during breastfeeding, unlike the other 97 children. In the case of exclusive breastfeeding, the incidence of HIV infection can be reduced even more.

Specialized care for children of HIV-positive mothers, as well as ARV prophylaxis If the mother received during pregnancy, ART, or HAART, the child immediately after birth to begin receiving antiretroviral prophylaxis with zidovudine syrup. The course of medication should be continued for at least one week. If during pregnancy the mother took ARV drugs at least 4 weeks duration of ZDV dosing for a child should be increased to four weeks, as well as an infant should receive the drug NVP immediately after birth. If a woman is undergoing treatment during pregnancy, gave birth to a baby through the birth canal, the newborn, in addition to ZDV, should receive one dose of NVP immediately after birth. If a woman did not pass during pregnancy treatment, or received NVP less than 2 hours before birth, the infant should receive 2 doses of NVP in the form of a suspension: first - immediately after birth, and the second - in 72 hours.

Beware of HIV infection