What Is HIV Infection?
HIV, or human immunodeficiency virus, attacks a person's immune system, making them vulnerable to diseases or infections. It is spread when a person comes into contact with the body fluids of an HIV-infected person. Sharing needles or injection equipment may also lead to the spread of the disease. HIV infection leads to a condition called acquired immunodeficiency syndrome (AIDS). It is the late stage of HIV infection.
Can a Pregnant Woman Transmit the Disease to the Fetus?
If a pregnant woman suffers from HIV infection or AIDS, there is a risk of transmission of the condition from the affected mother to the child. The transmission occurs in three stages: during pregnancy, childbirth, and while breastfeeding, through breast milk. Providing timely medical intervention helps reduce the risk of disease transmission, which may otherwise lead to severe symptom development or death in the mother and child. During pregnancy, the infections transmit through the placenta, affecting the fetus. During childbirth, the fetus comes into contact with the maternal blood and body fluids, leading to disease transmission. While breastfeeding, the infection is transmitted through the breast milk.
What Is Antiretroviral Therapy (ART)?
People with HIV can be treated with anti-HIV medications through antiretroviral therapy or ART. The replication of the virus causing HIV infection will be suppressed with the help of a combination of drugs. It is also called highly active antiretroviral therapy or HAART. This treatment will also decrease the development of resistant viruses. The quality of life of the infected person can be improved with the help of ART.
How to Use Antiretroviral Drugs During Pregnancy?
Pregnant women with HIV infection should start ART, or antiretroviral therapy, as early as possible. The initiation of the treatment is independent of CD4 T lymphocyte count and HIV RNA (ribonucleic acid) levels. This reduces the chances of perinatal transmission of the disease.
Low levels of HIV can be attained and sustained with the help of antiretroviral therapy during pregnancy. This prevents the transmission of the disease to the baby. Clinical trials for ARVs, or antiretroviral drugs, do not include pregnant women. This is responsible for the limited information on the workings of these drugs during pregnancy and breastfeeding.
While opting for the right ARV drugs during pregnancy through an effective conversation between the doctor and the patient, discussing and deciding based on the possible risks and benefits for the mother and the baby. The ARV drugs used during pregnancy can be of different types. When selecting ARV drugs, patients and healthcare providers should consider various factors. This includes the following factors:
-
The potential side effects or adverse drug reactions.
-
The possible interactions of the ARV medications.
-
The steps the body undertakes to process the drug.
-
The convenience level while taking the drugs.
-
The potential effects of the drugs when consumed during pregnancy.
-
The possible impact of the drug on pregnancy.
-
The mechanism of action of the drug in controlling HIV.
-
The underlying medical conditions of the patient.
How to Manage Pregnant Women With HIV?
HIV during pregnancy can be managed in the following ways:
Initiating ART: All pregnant or breastfeeding women suffering from HIV infections should receive ART. It is to improve the health and overall well-being of the patient and to prevent disease transmission to the sex partner or the fetus. ART should be started at fourteen weeks of gestation. If the condition is diagnosed during pregnancy, the mother should get ART immediately after diagnosis.
First-Line ART Regimens: The first-line ART regimen comprises nucleoside reverse-transcriptase inhibitors, or NRTI, and non-nucleoside reverse-transcriptase inhibitors, or NNRTI. It can also be provided by combining Tenofovir disoproxil fumarate (TDF), Emtricitabine, or FTC, and Efavirenz or EFV. Alternative therapy can be initiated if the drugs are inaccessible or contraindicated. This includes the combination of medicines like boosted PI or protease inhibitors, Azidothymidine, and more.
Continuing ART: If a woman on antiretroviral therapy gets pregnant, she should continue the treatment even after getting pregnant.
Starting ART Late During Pregnancy: If a woman gets diagnosed with HIV infection later during pregnancy, she should consult the healthcare provider and receive ART as soon as possible. In cases of high viral loads, the patient should receive a three or four-drug regimen.
Untreated HIV Patient: If an HIV-infected woman does not receive adequate treatment, they should be provided with the treatment during delivery. It can be initiated by giving Nevirapine, Zidovudine, Lamivudine, and Raltegravir.
Monitoring: Adequate blood and biochemical tests should be done based on the type of ART provided to the pregnant woman. HIV viral load should be assessed on a strict frequency basis. It should be done between 4 and 36 weeks after the initiation of the treatment. They should also be subjected to liver function tests.
Antenatal Care: An HIV patient is mostly susceptible to discrimination and stigma. The doctors and hospital management should be responsible for caring for, treating, and communicating with pregnant women with HIV infection. They should be treated the same way as a normal pregnant woman. They should be provided with privacy, and their infection status should be kept confidential. All types of fetal and maternal diagnostic and imaging tests should be performed on the patient. They should also be educated about future scanning, the requirement of treatment, and baby or fetal care.
Conclusion
HIV is an infection that severely impairs immunity. AIDS develops due to HIV infection. ART, or antiretroviral therapy, is the treatment option that improves the health and well-being of an HIV-infected person. In the case of pregnancy, pregnant women infected by HIV have the chance of transmitting the disease to the fetus or their sexual partner. HIV or AIDS can be life-threatening to the mother and the baby if not treated in time. They should consider initiating antiretroviral therapy as soon as possible. Even if the condition is diagnosed during pregnancy, the patient should consider getting the required treatment on an emergency basis. Pregnant women should initially be educated about the importance of taking ART.
