HIV Medications in Pregnancy: Necessity, Protocols, and Side Effects

Introduction:

Acquired immunodeficiency syndrome (AIDS) is a life-threatening condition caused by HIV (human immunodeficiency virus). Around 38.5 million people worldwide are suffering from AIDS. It is considered the world's most serious public health problem and an epidemic (widespread condition of an infectious disease). AIDS damages the body's immune system by disrupting the body's normal defense mechanism. This is associated with a spectrum of conditions caused by secondary infection and tissue changes. In this condition, normal bone marrow and blood cell functioning are also impaired, along with other tissues. During pregnancy, this may cause additional complications. Infection can transmit to the child, and it may cause significant pregnancy complications like fetal motility.

What Is HIV?

Human immunodeficiency viruses (HIV) are types of retrovirus. They enter the human body as single-stranded RNA ( ribonucleic acid) viruses. After entering the target cells, they change into double-stranded DNA (deoxyribonucleic acid) with the help of the reverse transcriptase enzyme. There are two types of HIV viruses one is HIV-1 is the most predominant virus, which is highly virulent and infectious. Another one is HIV-2, less infectious and mainly seen in West Africa.

• Transmission of HIV: The main mood of transmission of HIV is:

1. Through unprotected sexual contact. The virus can transmit through vaginal fluids, semen, and secretions of the genital organs.

2. During a blood transfusion, if the donor receives the blood of the affected person.

3. Needle prick is the most common cause of cross-contamination using the same needle that is off the infected person or sharing needles (occasionally done by drug addicts) may cause transmission of infection.

4. It can transmit the child from the mother during pregnancy.

5. This infection is not transmitted through touch, kissing, or saliva.

• Pathophysiology of HIV:

The envelope of the HIV viruses fused with the cell membranes of macrophages and CD4+T lymphocytes by adsorptions of glycoproteins. They can also infect dendritic cells (antigen-presenting cells) transmitted through the sexual route. After this, ribonucleic acid and various enzymes are injected into the cells. Here synthesis of complementary deoxyribonucleic acid (DNA). These infected CD4+ T-cells are destroyed by CD8+ T-cells. As a result, the number of CD4+ cells dropped dramatically. In the chronic phase, the drop in CD4+ T lymphocyte cells causes secondary infection. Infection also affects various cells like macrophages, monocytes, and microglia cells of the nervous system.

What Is HIV Staging?

Based on CD 4+ count and symptoms WHO (world health organization) has classified HIV staging. This is as follows:

1. Clinical Staging I: In this condition, patients are asymptomatic, and generalized involvement and swelling of the lymph nodes can be seen.

2. Clinical Staging II: Patients suffer from repeated respiratory tract infections which are associated with weight loss. Viral and fungal infections in the oral cavity and skin can be observed.

3. Clinical Staging III: Patients complain of severe weight loss and chronic diarrhea. Oral conditions like candidiasis and leucoplakia can be seen. Patients often suffer from pulmonary tuberculosis and pneumonia.

4. Clinical Staging IV: Severe infections associated with severe weight loss is observed in this condition. Apart from these, conditions like extrapulmonary tuberculosis, and Kaposi's sarcoma can be observed in this condition.

Why HIV Is a Concern for Pregnant Women?

One of the greatest complications of HIV in pregnancy is the transmission of the infant. This transmission mainly happens through two pathways. Fetal transmission may occur from the mother during pregnancy or during delivery. After delivery, HIV may be transmitted to the child via breastfeeding. Apart from this HIV may increase the chances of associated medical complications like hepatitis C and tubercular infection. Other sexually transmitted infections, urinary tract infections, and other infections are very commonly seen in pregnant mothers. Also, this is associated with stillbirth, preterm labor, preterm rupture of membranes, and low birth weight of the baby. To avoid such infections several treatment protocols have been introduced.

How to Identify the Conditions?

Identification of HIV infection in the early days of pregnancy is important. HIV should be tested as soon as the mother’s pregnancy test is positive. Repeated HIV tests must be done in the third trimester or tests should be repeated in case of patients who have a high chance of exposure. In case of suspected symptoms or infection from sexually transmitted diseases HIV test should be mandatorily done. If the person is already HIV-infected and receiving HIV treatment status of the disease should be evaluated. For this purpose, CD 4 + count is done.

What Is the Treatment Protocol?

Assessment of the HIV treatment status of the patient is necessary. Pre-exposure prophylaxis is one of the key factors in reducing the chance of HIV. It should be done for high-exposure persons or persons living in areas where the HIV infection rate is high.

• A combination of tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC) is prescribed daily for oral consumption for prophylaxis purposes.

If the patient is HIV positive and already under anti-retroviral therapy, it should be continued.

• Ideal anti-retroviral therapy is the administration of Zidovudine (300 milligrams twice daily) and Lamivudine(150 milligrams twice daily). In combination with these drugs Efavirenz (200 milligrams twice daily) or Nevirapine ( 600 milligrams once daily) is also advised. Another protocol of medication includes Tenofavir (300 milligrams once daily) along with Lamivudine ( 300 milligrams once daily or 150 milligrams twice daily if Nevirapine is used) and Efavirenz (600 milligrams once daily ) or Nevirapine ( 200 milligrams twice daily) is prescribed.

• The development of drug resistance is a major concern for HIV patients. Women are exposed to HIV therapy before the choice of treatment is changed. In such cases, non-nucleoside reverse transcriptase inhibitors are used for treatment purposes. In some cases, protease inhibitors are combined.

• Efavirenz is associated with neural tube defects. If the woman is diagnosed with pregnancy before the 28th day of pregnancy, it should be stopped, and Nevirapine should be continued in that place.

What Are the Potential Side Effects?

Anti-retroviral drugs are relatively safe. But certain drugs may cause impairment in the liver and renal function impairment. Also, in certain cases dizziness, and fatigue are normal side effects.

Conclusion:

HIV is a fetal viral disorder. HIV infection in pregnant women may transmit to the newborn baby. Also, HIV infection may be responsible for significant complications during pregnancy. Administration of anti-retroviral drugs can be helpful to prevent cross-transmission.