- Fortunately, the use of some specific drugs during pregnancy and labor (both Zeido Veodan Azido or thymidine) can reduce the risk of transmission of HIV to infants for the 70% approximately.
- In any case, all women do not realize they are infected with HIV; so experts stress that pregnant women undergo screening for infection with HIV.
In this presentation we will discuss the factors that can reduce HIV transmission from mothers to children in developed countries like America North; can also be a useful treatment in the developing world.
Care before pregnancy:
- Women should Almkhmujat HIV and who want to have children attending antenatal HIV specialist before trying to conceive; because many medicines are not safe for use during pregnancy and that may be necessary to be addressed before attempting pregnancy.
- Many of the studies conducted to understand the impact of HIV and treatment on the health of women and children a better understanding.
- Pregnancy or sign up to Almkhmugen infection worse and increase the risk of death with the virus.
- In any case did not clearly prove whether the virus or treatment increase the risk of pregnancy complications Kalkhaddaj and low birth weight and birth and Walid dead.
- It is clear that some HIV drugs both Zidovudine (Zeido Veodan Azido and thymidine) could reduce the risk of a reduction and a clear-born virus infection when the medication during pregnancy and labor; after the birth are given treatment for a child born.
- The Zeido Veodan given with other drugs for HIV as part of a three-drug regimen.
For him and the patient and her doctor to review your health-care center to know the risks and benefits of HIV treatment during pregnancy.
Drugs should be avoided:
There are many drugs used in the treatment of patients with AIDS should not be used in pregnant women and include:
• Efavirenz, which is used in the first trimester of pregnancy
• a combination of Stavudine (d4T) + Didanosine (ddI)
• Nevirapine women with a census of lymphocytes assistance Th (CD4) of more than 250 \ mm ³.
• Delavirdine which has become a rarely used today for the large number of pills to be taken daily is not recommended during pregnancy also.
Surveillance during pregnancy:
* For the duration of pregnancy should a pregnant woman infected with HIV to decline an obstetrician and a specialist in the field of HIV at regular intervals and durable. During these visits will be routine monitoring of gestation in addition to monitoring the evolution of HIV infection and this includes the examination of blood lymphocytes to detect population assistance from the pattern T (CD4) with control of viral load (amount of virus in the blood of the patient).
** Of the things recommended in the monitoring is to use detailed Eco (Eco-called level 2) in the weeks gestation of 18 to 20 to assess fetal growth.
Labor and birth with the incidence of HIV:
- The road safer for pregnant women infected with HIV for the birth of her baby based on assessment of viral load in blood during pregnancy, a woman pregnant with carrying a viral low (less than 1000 copies in ml of blood [relative to the PCR]) may be able to the birth of her child normal vaginal birth; while women pregnant pregnancy with the highest viral (1000 or more than 1000 copies in ml of blood [relative to the PCR]) are usually encouraged to establish a date for the caesarean section at 38 weeks pregnancy.
- The drug Zidovudine is used in the treatment of patients with HIV are usually given during childbirth, regardless of how is the process of birth (vaginal \ C-section) because Zidovudine helps to reduce the likelihood of infection with HIV from mother to child.
- And continue drug therapy treatment for HIV other during birth or by Caesarean section and this helps provide protection paramount to the mother and baby together, as well as to continue taking the drug even in the time of birth to minimize the development of resistance to drug in the mother due to the absence dose of medication was scheduled to be given to them.
Care during pregnancy:
Pregnant women infected with HIV usually need the help of several health service bodies during pregnancy and include:
• disease specialist HIV infection
• primary health care provider
• Provider gestation and obstetric care.
Initial assessment:
- After the proof of pregnancy when a woman infected with HIV, infected pregnant woman should see her doctor specialist disease HIV infection and her doctor responsible for providing care gestation.
- During these reviews, we will discuss how to treat a pregnant woman infected with the HIV virus during her pregnancy and how to reduce the risk of transmission of HIV infection to her fetus.
- During the initial assessment, the patient will undergo blood testing to determine the amount of viral load (the amount of viral units of HIV in the blood) as well as to determine how strong your immune system the patient (the number of lymphocytes assistance Th (CD4)).
- These numbers and the adjustments affect the success of treatment and the likelihood of transmission to the child either during pregnancy or delivery (birth).
Regimen for patients with HIV:
- Recommends that most women infected with HIV by taking combination therapy with anti-virus during pregnancy; used three types of anti-HIV drugs called HIV and that (treatment highly effective for the treatment of infection with HIV) (Highly Active Antiretroviral Therapy "HAART").
- If possible, add a drug Zidovudine (ZDV) because it has proven its ability to reduce the risk of transmission of HIV infection to the fetus, in addition to the belief that it is safe during pregnancy.
Timing of the treatment of HIV:
The timing of the beginning of treatment with HAART depends on the immune status enjoyed by women infected.
** If the patient is taking her medicine to maintain health and prevent dangerous developments of the disease if it should start (or return) of taking the drug immediately and without delay.
** If the treatment is not necessary now because of the availability of good immunity to the patient (risk analysis), if you delay eating HAART after the first trimester of pregnancy and to avoid unnecessary exposure of the child of the drug (causes fetal congenital problems).
** Once you start taking drugs should the patient return to take HAART to the end of pregnancy to prevent the child from becoming infected with HIV.
** Even if you did not use zidovudine during pregnancy; it is recommended (strongly) used during childbirth, and newborn for 6 weeks after birth.
Commitment to drugs during pregnancy:
- It is very important to meet the deadlines to take the drugs used in the treatment of HIV during pregnancy to reduce the risk of developing resistance to drugs used in treatment.
- And most of that interest until the desired pharmaceutical punctuality, is that taking the medicines on time for the patient can reduce the risk of transmission of infection with HIV to the fetus.
- Usually advised to detailed ultrasound (ECHO - level 2) during weeks 18-19 - 20 of pregnancy, and to assess the child's development. Advised to test ultrasound in a sequential manner during the second trimester and / or third to control the growth of the fetus.
Birth at the situation and infected with AIDS:
The safe way to be taken in pregnant HIV-infected depends on the level of virus in the blood.
Women with low blood levels of HIV (less than 1000 copies / mL) may be able to natural childbirth (vaginal).
Women with high blood levels is the way in a Caesarean section in week 38 of pregnancy.
given Zidovudine (antiretroviral) usually during the birth process, regardless of the mode of delivery, whether natural or Caesarean section, because this medicine reduces the risk of vertical transmission route.
There are other anti-viral therapy that may be given during a natural birth or by Caesarean section, which helps in strengthening the protection of a super mother and her unborn child, and reduce the risk of drug resistance because of the wrong drug dose.
With blood levels of the virus is discovered:
- Women who are abusing anti-virus Gahgahria, and have levels of blood is exposed to the virus, preferably giving birth during the two weeks 34-36 in any way, where - in this case - the risk of transmitting the virus to the fetus through the natural birth too young not to exceed 2% or even less.
- Either by Caesarean section - is not entirely clear - it can decrease the risk of transmission.
- The patient must be aware of the risks and benefits of cesarean delivery for the birth by a doctor of natural women.
With levels greater than 1000 copies / mL:
- AIDS, pregnant and sick with a viral blood levels are high, recommend between weeks 34-36 to have a Caesarean section being preferably a natural birth.
- This situation is caesarean section a week 38 of pregnancy.
- Studies have shown the women was not given anti-retroviral anti-HIV, the cesarean delivery in vivo before the start of labor, could reduce the risk of HIV transmission by 50%.
- If a woman taking anti-viral therapy for AIDS, but was discovered by a viral infection (more than 1000 copies \ ml) close to the time of pregnancy, cesarean Having a baby has a similar benefit in reducing the viral transition to AIDS among women and children.
In another mode - a woman with a viral infection among AIDS (0000-1000 copies \ ml), which continue to antiretroviral therapy during pregnancy may be able to choose between vaginal delivery and caesarean section.
- Does not have enough information from the studies conducted to know whether the cesarean delivery reduces the risk of HIV transmission in young HIV (AIDS) for the newborn.
- Scheduling of interest (which is held in place according to schedule times) cesarean delivery be to minimize fetal exposure to maternal blood.
- Can lead hazards that occur to the cesarean birth complications for the mother (haemorrhage - sepsis -.... Etc.)
And can be more difficult to recover after the Caesarean section compared with vaginal delivery.
Post-natal care for women:
o After Childbirth - Women who take anti-viral therapy during pregnancy need to be evaluated by taking the decision to continue treatment with anti-viral. This decision must be assessed and a good time with a specialist AIDS.
o Continue to health care and support services including medical care for patients with AIDS-related, psychological and social support and provide assistance in planning and birth control with the family; can also help women take care of personal and family needs.
Lactation:
- Women infected with HIV that are breast-feeding can transmit the virus to the baby.
- In one study conducted on more than 600 pairs (mother - and her baby) from Malawi, the risk of transfer of HIV to the infant through breast-feeding 7 percent of infants who were breastfed for one year and 10 percent for infants who were breastfed for more than two years.
- In the United States and other countries rich in resources; There are several alternative means of feeding from the breast (such as water and clean food for babies). Therefore, the U.S. Public Health Service recommends that women infected with HIV and living in the resource-rich countries not to breastfeed her children from her breast; even if they engaged in anti-viral drugs backwards. Where the virus may be transmitted through breast milk, even if these drugs are dealt.
- But can not be generalized this advice to all women; that in countries where few resources were not available safe alternatives to breast milk ever.
When infants and children:
Measure the treatment of HIV: The newborn for HIV-positive women are usually treated with Bal Zidovudine for the first six weeks of life. As the Zidovudine helps protect infants from HIV infection (which may result from being the mother's blood during birth).
In some cases, the drugs antiretroviral may be given individually or in conjunction with the Zidovudine; It also reviews the patient and her doctor to determine the health status of an antibiotic drug is best for her.
HIV testing:
Usually adults and children subject to the examination of virus antigens to determine whether they have been infected with the virus or not ..
In any case, the virus antigen testing of infants for the possibility of inaccurate and received from the mother. Which leads to the emergence of positive results in screening, although the baby is not infected.
Tested for infection with HIV:
naturally subject to adults and children to be tested for antibodies to the virus HIV, which indicates a person is screened Balkhmj with the virus, with the exception of newborns because the antibodies that detect in the blood may have come from the mother and transferred to the child, and despite the presence of antibodies and a positive test in these newborn birth but it is not necessary to be infected Balkhmj.
For this reason, applied to the neonatal special test measures the presence and the quantity of virus present HIV in their blood to see if they really have or not ...
If the result of this test is private (known examined HIV PCR _ because it is supported on a PCR_) is negative, it means that the child is not infected with the virus.
in newborns by their mothers took the drug anti-HIV virus during pregnancy, the baby is not infected (- HIV) if he was given at least two tests (HIV PCR) ages (<1 month, and <4 months) and the result was negative.
If the result in one of the tests (HIV PCR) positive, we will re-test again to confirm a child with HIV (+ HIV).
Prevention of infections:
- Newborns infected with HIV are at risk of a pattern of women with lung, called (with pulmonary lung Palmtkish Karen).
- It is recommended that the user is taken the antibiotic for the prevention of this disease every day, starting from the age of 6 weeks, after completion of therapy Zidovudine.
- But remains a need for drugs to prevent infections based on test results (HIV PCR) in children.
Intensive follow-up and long-term for children:
- Studies of neonatal _ for HIV-positive mothers HIV_ and who took the drug zidovudine, and resulted in a positive non-infected Balkhmj with HIV showed _ these studies _ an increase in the risk of these children newborn to the problems during the process of growth and until the age of 6 years at the level of:
• immune system
• brain function
• Injuries cancer
• and other problems ....
- On the other hand, information is not available due to long-term studies in relation to the safety of anti-HIV during pregnancy, as a result of this: newborns who were exposed to drugs of anti-HIV, during the gestation period of their mothers, they must be subject to monitoring and follow-up over the life experienced by the these children.
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