Pregnancy and birth management in HIV/ AIDS patients

Abstract

Introduction. Human immunodeficiency virus (HIV) is an infection with a global prevalence and currently no cure or vaccine. If left untreated, the condition progresses to Acquired Immunodeficiency Syndrome (AIDS) which is the end stage of the HIV infection. Women can pass on this disease to the fetus or child during pregnancy, childbirth and through breastfeeding. Vertical transmission occurs 20% before 36 weeks, over 80%- around the time of labor and delivery. An important strategy in preventing the transmission of the virus is realized by counseling, testing pregnant women, providing antiretroviral treatment, cesarean delivery and exclusive artificial feeding of newborns. Aim of study. The assessment of the diagnostic and treatment methods in HIV positive women and fetuses. Methods and materials. In order to identify opportune articles, I searched different databases as ScienceDirect, Medscape, PubMed, using the Key words: “Human immunodeficiency virus in pregnancy”, “vertical transmission”, “diagnosis of HIV”, “antiretroviral treatment”, ”management in HIV patients”. Results. The study highlights that the diagnosis of HIV is based on laboratory tests: anti-HIV antibodies, P24 antigen, HIV DNA test, HIV RNA test, viral culture. Firstly, the detection of anti-HIV antibodies is realized due to standard serologic tests ELISA and Western blot, which have a 99.9% sensibility. EIA is considered a screening test, while Western Blotting being the confirmatory test. All newborns from HIV positive women have anti-HIV antibodies until 18months, that’s why the positive results don’t confirm the infection. Secondly, the P24 antigen can be detected in the blood, but it has a low sensibility in the first months of life. More informative for neonatal infection is HIV DNA test (PCR), necessary to all newborns exposed to HIV, not later than 48h, before ART. Thirdly, the viral culture is a high sensibility test, but it’s expensive and results are done in 2-3 weeks, that’s why it has been supplanted by NAATs. In addition, it is important to control complete blood count, liver and kidney function tests, the Conclusion. Pregnant women should be diagnosed as fast as possible in order to adopt the relevant management to prevent the transmission of the virus to the fetus. Perinatal HIV transmission is preventable with appropriate maternal HIV screening and early initiation of ART if the screening test is positive. The study highlights diagnostic and treatment methods in HIV positive women and fetuses.