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? 

Sexual mode is the major route of spread of HIV infection globally. Heterosexual intercourse accounts for 82% cases of HIV transmission in India. The risk of HIV infection with sexual intercourse is 1% per episode with an increased risk associated with female gender, presence of other sexually transmitted diseases and pattern of sexual behavior. There is a higher risk of male to female transmission compared to female to male transmission (8 times) due to the large surface area of the vagina, prolonged exposure to semen and trauma to the vagina during intercourse. Getting a blood transfusion with infected blood carries a 90- 100 % risk of contracting HIV infection. It is important to know that despite the strict control by the government on the screening of blood before transfusion and the crackdown of professional blood donors, there still exists a risk of 7 people accidentally getting AIDS through contaminated blood per every one million people getting a blood transfusion. This emphasizes the need for giving blood and its products only to those people who really need it. Infected needles are an important source of HIV infection for health care professionals like doctors and nurses and for intravenous drug addicts. Hollow bore needles are associated with 8 times increased risk of infection than a surgical needle. Needle prick with an infected hollow bore needle is associated with a 0.3% chance of HIV transmission.

Clinical course of HIV in the body

Exposure to HIV is followed by an incubation period, which lasts for about 3-6 weeks followed by a period of rapid multiplication of the virus in the body called Acute HIV syndrome in 60-70% cases. This syndrome is similar to other viral illnesses with mild fever, body ache etc. This is followed by a period of immune response of the body, which reduces the virus levels in the body to very low counts. The diagnosis of HIV infection by lab tests may be missed by antibody based detection methods (the most commonly done lab test for AIDS) for up to 2 months following the HIV infection. This period is also known as the window period. The disease then lies low in the body for up to 6-8 years following which the virus again becomes stronger than the body and there comes the final stage of full-blown AIDS