In the past few years, the HIV (Human Immunodeficiency Virus) has brought unpleasantness and deaths among pregnant women. The HIV infection has grown by leaps and bound in the women population especially women in the child bearing age. This has resulted in a large number of children also acquiring this disease through prenatal (mother to infant) transmission. This has also resulted in a sharp increase in the number of cases of AIDS (Acquired Immunodeficiency Syndrome). The HIV infection also is causing a large number of deaths among children. To get out of this situation it is very essential that education and services for prevention of HIV must be available to all women who are pregnant or want to become pregnant.
Pregnant Women who suffer from HIV infection need to become aware of some information during their pregnancy such as:
- How risk for prenatal HIV transmission can be reduced?
- How can HIV infection in pregnant women and parentally infected children be managed?
- How can the survival rates and quality of life of HIV infected people be improved?
The basic plan to curb prenatal HIV transmission is to make prenatal HIV testing of pregnant woman compulsory. There can be three different prenatal HIV testing techniques –
- Opt-in – In this technique, a counseling session on HIV test is done for the pregnant women and they volunteer for an antibody test.
- Opt-out – In this technique, women are advised that an HIV test will be conducted along with the other routine prenatal test and they may refuse it if they so wish.
- Mandatory newborn HIV testing – In this technique all the babies born have to go through a mandatory HIV status test, whether the mother’s HIV status is confirmed at the time of the delivery or not.
For a carrying woman suffering from HIV the chances of passing it on to her baby are as high as 25 percent. For them, it is of utmost importance to get good prenatal care and services of a health care provider. The treatment to be followed is very similar to any other non pregnant woman. Initially they are asked to get a PAP test done and then a CD4 count. During the pregnancy another CD4 count may be required depending on your count during the first test.
In an ideal situation today, every woman should know her HIV infection status before going in for pregnancy. Organizations working in areas like family planning clinics, sexually transmitted disease clinics, and adolescent clinics should have voluntary HIV testing and counseling to women and adolescents regardless of the fact that they are pregnant or not. All pregnant women should go in for routine HIV counseling and testing so that in case of any infection, there can be timely and effective intervention and a life can be saved.
After a random testing, it has been found that an administration of Zidovudine (ZDV or AZT) in HIV infected pregnant women and their newborns reduce the risk of prenatal HIV transmission considerably. This drug benefits the most when the HIV virus is detected before pregnancy or during early pregnancy.
AZT treatment is done in three regimens –
- From the 14th week of pregnancy till 34th week, a HIV infected pregnant women needs to take AZT. The dosage is at least 600 mg in a day, which can be taken as either 100mg five times a day or 200 mg three times a day or 300 mg twice a day.
- During labor and delivery, AZT should be administered intravenously.
- The new born should also be given AZT (in liquid form) every 6 hours for 6 weeks after delivery.
After this three regiment treatment of AZT, the chances of the new born getting HIV infection are reduced by 70 percent. For a HIV pregnant woman the AZT therapy is a gift of God and cannot be undercut. Still the effect of the drug in reducing HIV transmission from the mother to the infant cannot be fully explained from this therapy. A lot of research and development needs to done to ensure the technique involved to reduce prenatal transmission by AZT is safe. The risk factors involved in transmission at all levels of maternal viral load, also need to be found. Apart from these, other anti-HIV medications can help to treat the infection along with providing extra protection to the baby.