HIV infection has become an epidemic in the past few years with an estimated 61 million affected people worldwide, another 7 million are added every year as per UNAIDS, the United Nations watchdog for AIDS. With 27 million pregnancies every year in India, it is estimated that about 100,000 HIV infected women deliver every year. From infected pregnant women about 30,000 infants acquire HIV in India every year. Human immunodeficiency Virus (HIV) belongs to a family of slow acting Lenti viruses that uses a special enzyme (a kind or protein) for replication. The virus binds to the immune cells (cells in the human body that protect it against infections) of the body and kills them. This leads to a progressive decline in the number and function of these immune cells, which in turn causes impairment of the immunity in the body. Low levels of immunity leads to an increased risk of infections and some type of cancers. There is no evidence to suggest that pregnancy hastens the progression of HIV infection. However women who have HIV have a higher chance of abortion, small babies and an early delivery. The virus travels from the mother to the baby at three different times during pregnancy. Most commonly the baby gets infected while it is still in the womb, next commonly during delivery and least commonly after delivery by taking the infected mothers’ breast milk. More advanced is the mother’s disease, higher is the chance of the baby acquiring HIV from its mother. Any pregnant women with HIV should be counseled about the nature of the disease, the need for long term treatment and general measures for HIV infection. She should be explained the risk to her and to the baby due to her infection. The option for termination of pregnancy should be discussed with her. The primary mode of treatment of HIV positive women is administration of HAART (highly active antiretroviral therapy) started anytime after three and a half months of pregnancy. This consists taking oral medicines against HIV at home. It decreases the risk of the baby having HIV from 45% to around 8%. These medicines, which earlier had a very prohibitive cost are now available in generic versions at affordable prices, and can be taken at home. The type of delivery is very important in decreasing the risk of HIV transmission from mother to child. It is recommended by the American College of Obstetricians and Gynecologists that Caesarean section should be done for all women to decrease the risk of infection to the baby further from 8% to 2%. Even women who have started having natural labor pains benefit from having a C section. Centre for disease Control and Prevention, USA recommends avoidance of breastfeeding in HIV positive women. World Health Organization however recommends exclusive breastfeeding in women who do not have enough money to buy formula feed, but breastfeeding should be exclusive and should stop at four months of age of the baby. Giving a child a mixed diet of breast milk and formula feeds is worse for the baby as formula milk causes inflammation of the childs intestine from which the HIV virus can easily enter the body of the child. All children born to HIV positive mothers should get Zidovudine (an antiHIV drug) and should be tested for HIV at birth and again at 6 weeks and 6 months and treated accordingly. A good part of HIV transfer from mother to child is preventable through simple means. Women should be counseled for the same and helped in containing the virus. How does AIDS spread?
Clinical course of HIV in the body
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