HIV infection in pregnant women

The human immunodeficiency virus (HIV) is an anthroponotic infection characterized by progressive damage to the immune system leading to the development of acquired immunodeficiency syndrome (AIDS) and death from secondary diseases. The causative agent belongs to the family of retroviruses ( Retroviridae ), a subfamily of slow viruses ( Lentivirus ).

ICD-10 code

• 098.9 Infectious and parasitic diseases of the mother complicating pregnancy, childbirth or the puerperium, unspecified.

Forms

Classification of HIV infection

According to V.I. Pokrovsky (established in 1989, modified in 2001), distinguish the following stages of HIV infection:

1. The stage of incubation is the period from the moment of infection until the appearance of signs of acute infection and / or the production of antibodies.
2. The stage of early HIV infection is the primary response of the organism to the introduction of the pathogen in the form of clinical manifestations and / or the production of antibodies. Current options:
   • asymptomatic seroconversion;
   • acute HIV infection without secondary manifestations.
3. Subclinical stage - there is a slow progression of immunodeficiency with a gradual decrease in the level of CD4-lymphocytes, moderate replication of the virus and minor lymphadenopathy.
4. The stage of secondary diseases is the continuing replication of HIV, leading to the death of CD4-lymphocytes and depletion of their population, development of secondary (opportunistic), infectious and / or oncological diseases against the background of immunodeficiency. Depending on the severity of secondary diseases, the stages IVA, IVB, IVB are isolated.
5. The terminal stage - secondary diseases acquire an irreversible course, the therapy does not yield results, patients die within several months. In adults, the time from infection to the appearance of clinical manifestations of the disease is usually 2-4 weeks, but cases of a longer incubation period are described - up to 10 months.

Seroconversion - the appearance of antibodies to HIV - occurs within 3-12 weeks after infection.

The duration of the stage of primary clinical manifestations is 5-44 days (in 50% of patients 1-2 weeks).

The latent period following the stage of primary clinical manifestations can last many years (from 2 to 20 years and more).

As determined by the US Centers for Disease Control, the diagnosis of AIDS is established in patients with antibodies to HIV, with CD4-lymphocyte counts less than 200 in 1 μl and the presence of one of the AIDS-indicator diseases. Of the AIDS-indicator diseases in our country the most common are:

• tuberculosis;
• candidiasis of the esophagus, trachea, bronchi and lungs;
• cytomegalovirus infection;
• Kaposi's sarcoma;
• pneumocystis pneumonia;
• toxoplasmosis.

Highly active antiretroviral therapy can stop the natural progression of the infection. Due to the improvement of the immune status, the development or cure of opportunistic infections is prevented, the life expectancy of patients is increased. However, not all patients receiving antiretroviral therapy respond to treatment: they may progress to the disease with the development of secondary and opportunistic diseases.

Infection with HIV can occur in the following ways:

• sexual (with heterosexual and homosexual contacts);
• injecting (when injecting drugs with common needles and syringes);
• instrumental (when using non-disinfected medical equipment: endoscopes, surgical instruments, gynecological mirrors, dental burs, and gloves, etc.);
• blood transfusion (with transfusion of contaminated donor blood or its components);
• transplantation (with the transplantation of donor organs, artificial insemination with donor sperm, staying in the period of seronegative "window");
• professional (contamination of medical workers through damaged skin and mucous membranes in contact with infected blood or other discharges of HIV-infected people);
• perinatal (vertical - transmission from mother to child during pregnancy and childbirth, horizontal - during breastfeeding, and transmission of HIV from an infected child to a healthy woman breastfeeding it).

HIV infection in pregnant women - Epidemiology

[1], [2], [3], [4], [5], [6], [7], [8], [9]

Diagnostics of the hIV infection in pregnant women

Diagnosis of HIV infection in pregnancy

Diagnosis of HIV infection includes 2 stages:

• the actual establishment of the fact of HIV infection;
• the definition of the stage, the nature of the course and the prognosis of the disease.

Diagnosis is based on a comprehensive assessment of epidemiological data, clinical examination results and laboratory studies.

[10], [11], [12], [13]

Laboratory research

• Immunoenzyme analysis - a screening test that detects antibodies to HIV in the blood serum, is performed with voluntary testing, in conjunction with a diagnostic examination of patients, and also according to clinical indications. In case of a positive result, the analysis in the laboratory is carried out twice (with the same serum) and when receiving at least one more positive result, the serum is sent to establish a confirmatory test.
  • The earliest time of detection of antibodies is 2 weeks from the moment of infection.
  • In 90-95% of patients, antibodies appear within 3 months.
  • In 5-9% of patients - after 6 months.
  • In 0.5-1% of patients - at a later date.

HIV infection in pregnant women - Diagnosis

The main goal of treatment of patients with HIV infection is prolongation of life with maximum preservation of its quality.

Treatment of the hIV infection in pregnant women

Basic principles of treatment of HIV infection in pregnant women

• Creating a protective psychological regime.
• Timely initiation of effective antiretroviral therapy and prevention of secondary diseases.
• Careful selection of the required minimum of medicines.
• Early diagnosis and timely treatment of secondary diseases. For the treatment of HIV infection and AIDS, the following drugs are used:
  • HIV reverse transcriptase inhibitors;
  • HIV protease inhibitors;
  • preparations from the group of interferon inducers possessing nonspecific antiviral activity.

HIV infection in pregnant women - Treatment

[14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26]