Lesson 27 – What To Do When You Detect Hiv Infection During Pregnancy?
"Children are an anchor to a mother's life ..." (Sophocles - Pheadra). Especially when the mother has health problems, related to the life and future of both mother and child - one of which is infected with HIV (Human immunodeficency virus). The decision to keep the child is a courageous and responsible decision.
What to do when you detect HIV infection during pregnancy?
According to statistics of the first 6 months of 2013 of the Ministry of Health, HIV prevalence in Vietnam is 243 / 100,000 population; There are 65,133 deaths from AIDS. People with HIV are concentrated mainly in the group of 30 - 39 years old - of reproductive age
If detected early, using antiretroviral treatment (ART) for mothers and infants can reduce the rate of infection for children from 25% to 2%, even lower. Even when only zidovudine is used during labor and the first 24 - 48 hours after birth there is a significant reduction in the incidence of the infection, the rate of mother to child transmission is less than 10%. For these reasons, it is possible to keep a baby when she finds out she has HIV. The remaining issue is what measures to take to minimize risks for the baby during pregnancy and healthy birth.
Is HIV testing necessary for all pregnant mothers?
The answer is "Yes", all pregnant women need HIV screening tests as a routine test during pregnancy, regardless of risk group (ACOG, 2011). If a woman refuses to test because she has had a negative result before, it is important to explain the meaning and importance of a retest in this pregnancy. As recommended by the American Society of Obstetricians and Gynecologists (ACOG), screening tests are performed as soon as the diagnosis is made for pregnancy, in the first 3 months of pregnancy
In order to make a definite diagnosis of HIV infection, a complete set of tests should be performed in the following order: positive rapid test, positive HIV antibody (ELISA), Western blot or positive immunofluorescence (IFA) test. Even when ELISA is positive, it is not possible to diagnose HIV infection without a positive Western blot or IFA result. The sensitivity and specificity of ELISA and IFA or Western blot> 99%. The false positive rate when both tests are positive is 1 in 59,000 cases. If the ELISA is positive that Western blot or IFA is negative, no diagnosis of HIV infection, no repeat test is needed.
Some recommendations of ACOG when detecting a rapid HIV positive test
Counseling is likely to be made of HIV and the possibility of transmission to the child.
Explain the limited meaning of rapid testing, the possibility of false positives and the importance of subsequent tests for definitive diagnosis.
Specialized referrals are required to perform a definite diagnostic test.
Immediately start prophylactic antiviral drugs, without waiting for the results of a definitive diagnostic test to minimize the risk of transmission to the child.
When the mother is born, its use depends on the results of the definitive diagnostic tests.
Advise the mother to postpone breastfeeding until the results are available. If really infected with HIV, do not breastfeed.
If the mother has been confirmed to be infected with HIV, notify the neonatologist to carry out diagnostic and treatment regimens for the child.
What should i keep in mind when pregnant with HIV-infected mothers?
Monitoring and care of an HIV-infected pregnant woman requires a combination of specialties such as obstetrics, internal medicine, infectious and psychological. Limitations of the article will not address preventive measures because of the many complex issues involved. From the perspective of an obstetrician, please only discuss issues related to screening for fetal aneuploidy in the first 3 months of pregnancy.
In a normal pregnancy, when a chromosomal abnormality is suspected with a blood test, nuchal translucency (NT), the pregnant mother is advised to do invasive procedures such as a thoracic biopsy. or amniocentesis. For an HIV-infected pregnant woman, these procedures increase the risk of HIV transmission to the baby. Will the endocrine concentration of an HIV-infected mother differ from the uninfected mother due to immunosuppression, or will the use of antiviral drugs alter the endocrine concentration resulting in unnecessary indications?
Studies of hormonal screening levels for pregnant women with HIV have shown conflicting results. Research by Savvidov et al (2010) on 90 HIV-positive pregnant women and 450 uninfected pregnant women showed no statistically significant differences in free b-hCG, PAPP-A and NT concentrations in the two groups. . When analyzing subgroups with and without ART, the corrected concentrations (MoM) of free b-hCG were lower in the non-treated and HIV-negative groups. Theoretically, this change.
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