The human immunodeficiency virus, also known as HIV, is a virus that causes AIDS (acquired immune deficiency syndrome). The incurable virus attacks the body's immune system, making the body extremely vulnerable to opportunistic infections (infections that occur in patients who have weakened immune systems).
HIV is transmitted from person to person via bodily fluids, including blood, semen, vaginal discharge, and breast milk.
Mother-to-child transmission (MTCT), also known as vertical transmission, occurs when an HIV-positive woman passes the virus to her baby. This can occur during pregnancy, labor, delivery or breastfeeding. Without preventative antiretroviral treatment, about 15-30% of babies born to HIV-positive women will become infected with HIV during pregnancy or delivery. An additional 5-20% will become infected through breastfeeding.
According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), about 700,000 children younger than 15 years old became infected with HIV, mainly through MTCT in 2005. About 90% of these MTCT infections occurred in Africa. This is because of the high prevalence of HIV infection, lack of HIV screening, and poor access to obstetricians/gynecologists and antiretroviral therapy.
In high-income countries, including the United States, MTCT has been practically eliminated with the use of voluntary HIV testing and counseling, access to antiretroviral therapy, safe delivery practices and the widespread availability, and safe use of baby formulas. In fact, perinatal (shortly before or after birth) HIV infection rates can drop to as low as one to two percent for babies if their mothers take combination antiretroviral therapy during pregnancy, as well as zidovudine (AZT) or nevirapine preventative therapy during labor and after birth. While a cesarean section (surgical delivery of a baby), also called a C-section, can reduce the risk of transmission during birth, it is not typically necessary in patients who undergo antiretroviral therapy.
According to several studies, HIV-positive women who become pregnant do not become sicker than HIV-positive women who do not become pregnant.
While pregnancy itself is not considered dangerous to an HIV-infected woman, short-term antiretroviral monotherapy (taking a single antiretroviral drug) to prevent transmission to the newborn can be. This is because the mother has a higher risk of becoming resistant to treatment. When this happens, the medication does not effectively suppress the virus. Once a patient is resistant to a drug, the patient can no longer take the drug in the future because it is ineffective.
Therefore, combination antiretroviral therapies are the standard treatment for HIV-infected pregnant women. When drugs are combined, different stages of HIV's replication are suppresses because each drug works differently. Combination antiretroviral therapy has proven to be a more effective practice than monotherapy. However, if the pregnant woman only takes medications during labor and delivery, she is also at risk of becoming resistant to the drug.
Patients typically do not begin antiretroviral therapy until after the first trimester. This is because the risk of birth defects caused by antiretroviral medication is greatest during the first three months of pregnancy. However, if the HIV-infected mother chooses to discontinue taking some medications during pregnancy or does not adhere to the specific drug regimen prescribed, the HIV infection could worsen. Patients should always discuss the potential health benefits and risks of treatment options with their healthcare providers.
According to one cohort study, HIV-infected pregnant women are more likely to adhere to antiretroviral therapy than non-pregnant HIV-infected women. Researchers measured adherence by pill counting and self-reporting. 43.1% of pregnant women adhered to treatment, according to pill counting requirements, compared with 17.7% of non-pregnant women.
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