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Anastasia Patran
Anastasia Patran Infectious disease specialist at the Children+ charity foundation.
As of December 31, 2021, there are about 1.5 million people living with HIV in Russia living with HIV in the Russian Federation. More than 37% of them are women, and every year their share is growing. Even 20 years ago, many of them would hardly have dared to conceive a child because of the difficulties in obtaining medicines and the fears imposed by society. But today, modern antiretroviral therapy (ART) allows you to give birth to a healthy baby, even if HIV was detected in a woman in the third trimester of pregnancy.
We tell what preventive measures exist to prevent the transmission of the virus from mother to child, and also give stories of women who have gone through this.
How a woman with HIV should prepare for conception
An important factor that affects the risk of HIV transmission is the amount of virus in the blood of a positive partner. The smaller it is, the lower the risk of getting an infection. Special antiretroviral therapy helps to reduce the number of copies.
Within a few months of taking the medication, copies of HIV become so small that the test systems cannot register it. This is called undetectableUndetectable means a non-transmitting/Life4me+ viral load.
Therefore, before planning a pregnancy, a woman with HIV should take special medications for at least six months. The doctor will select options that are safe for both the fetus and the patient herself. In addition, the couple needs to be tested for sexually transmitted infections and receive appropriate treatment if they are found.
In the future, the woman will need to be constantly monitored by an infectious disease specialist, as well as by an obstetrician-gynecologist at the AIDS Center.
Nadezhda is 34 years old.
I got HIV from a young man in 2011 when I was 23 years old. I was sick for a long time, I had a high temperature and all the consequences. Then everything went away, but the inflamed lymph nodes remained. A friend of mine was being treated for cancer at the time, and a similar symptom just pointed to cancer, so I decided to get checked out by a doctor.
They took tests, and it turned out that I have HIV. I was a classic bearer of myths that “this is a disease of prostitutes and drug addicts,” so the news of the diagnosis came as a shock to me. I didn't even know there was a cure.
At the AIDS Center, I came across very cool doctors and a psychologist who did not let me “go cuckoo”. Mom, on the other hand, had a harder time, because she accompanied me all the time, and I am her only child. Over time, I began to attend self-help groups, and when I saw that people with HIV live a normal life – they rejoice, laugh, give birth to children, go on vacation – I began to calm down.
In 2013, I met my future husband, we A discordant couple is when one partner is HIV negative and the other is HIV positive. He calmly reacted to the news and even at first tried to find some ways to get me medicines from abroad.
At that time, there were no protocols according to which drugs should be taken immediately after it becomes known about HIV. Infectionists waited until immunity decreased, and only then prescribed treatment.
In 2014, we got married. At that time, I was already taking drugs, I had an undetectable load in the blood. We knew that “undefined = non-transmitting”. That is, in this state, there are so few copies of the virus in the blood that I cannot pass it on to another person even without using contraceptives.
So we decided to have a baby. I approached this very responsibly: I passed all the tests, started drinking vitamins. And when I got pregnant, I was absolutely healthy – except for the fact that I had HIV.
I gave birth to my daughter on my own, after giving birth she was given syrup with an ARVT drug. And a year and a half after discharge, they were deregistered at the AIDS Center.
How to protect a child from the virus if HIV was detected during pregnancy
A registered pregnant woman must be tested for HIV twice: in the first trimester and at the 30th week. Usually the virus is detected immediately. But sometimes she does not immediately get registered in the antenatal clinic or becomes infected at a later date, and then the disease becomes known only during the second test.
If the first analysis shows the presence of antibodies to the immunodeficiency virus, the woman is sent for a second study to the regional Center for the Prevention and Control of AIDS at the place of registration.
With a repeated positive result, the infectious disease doctor selects antiretroviral therapy, the task of which is to reduce the number of copies of the virus in the blood to a state in which a woman cannot transmit it to another person through any biological fluids.
Prevention of perinatal transmission of the virus has been carried out in Russia since 2003 – then the Ministry of Health of the Russian Federation issued an order. which legally provides women in labor with a set of measures designed to protect the child from the transmission of the virus. It includes three stages.
1. Prevention during pregnancy.Immediately after the detection of the virus, the doctor selects a treatment regimen, taking into account the girl's concomitant diseases, her lifestyle and the possible use of other drugs. Treatment is considered effective if the drugs can reduce the number of copies of the virus in the blood at least 10 times within a month. If this does not happen, the infectious disease specialist selects a different scheme.
Before giving birth, the woman is once again checked for the number of copies of the virus in the blood in order to develop tactics for labor activity. If the load is undetectable, the infectious disease specialist may recommend that she give birth naturally. If not, he advises a caesarean section to minimize the contact of the child with the mother's body fluids.
2. Dropper with ART drug during childbirth.Immediately after the onset of labor, the pregnant woman is given an intravenous solution of antiretroviral medication and continues to drip until the umbilical cord is cut.
3. Postpartum HIV prevention. Immediately after birth, the child is prescribed syrup with ARVT drugs, and the woman is also strongly advised to stop breastfeeding. This applies to expressed milk, and breastfeeding. In the AIDS Centers, babies who have just given birth are given formula.
Up to a year, a baby is tested three times for the immunodeficiency virus: in the hospital, in the first month of life and in the fourth month. If necessary, the pediatrician may prescribe additional tests: biochemical, immune status, hematological examination. And also – an analysis for hepatitis C, which is often a concomitant disease with HIV.
Up to a year and a half, the child is registered with the AIDS Center for perinatal contact. It is believed that upon reaching this age, his immunity completely gets rid of maternal memory antibodies, which can show a positive result for HIV.
In some children, this happens a little earlier, in others – later, depending on individual characteristics. After the antibody test shows a negative result, the child is removed from the register.
Elena is 37 years old.
I found out that I have HIV when I was pregnant with my third child. I got a call from the antenatal clinic, they said that I urgently need to drive up and retake the tests at MONIKI, the State Budgetary Institution of Healthcare of the Moscow Region “Moscow Regional Research Clinical Institute named after M.F. Vladimirsky”.
I was surprised and clarified, why is this necessary, to which the doctor carefully asked, is it really the first time I have come across such a request and whether my tests were in order before. I confirmed what it was for the first time, after which I was asked to retake the HIV test. But the result was again positive.
I was shocked. Firstly, I am pregnant, and secondly, the first two children are healthy and it is not clear where the virus comes from. Thirdly, it is not clear how to live on. Later it turned out that I got the virus from my husband, it's just that it is not always transmitted during heterosexual sex, even if you do not protect yourself.
I was given medication right away. Since it was only the first trimester, the amount of virus in the blood was quickly reduced. As a result, I spent most of my pregnancy with an undetectable load. I was worried about the toxicity of the drugs, but the specialists from the “School of Patients” convinced me that now it is possible to give birth to an absolutely healthy child and live in peace, if you do not ignore ART therapy, and somehow I immediately believed them.
I gave birth under a drip, but without a caesarean section, although I know that it is quite often prescribed in such cases. My son was healthy, he was immediately registered with the AIDS Center, but closer to two years we were removed from there, because all the tests showed a negative result.
In 2021, HIV-infected women in Russia gave birth to HIV infection in the Russian Federation as of December 31, 2021, more than 13 thousand children. The virus was found in only 1% of newborns. As a rule, it was transmitted from mother to child only when a woman did not go to doctors during pregnancy or did not take ART therapy due to personal beliefs.
At the same time, modern drugs allow you to live a long and fulfilling life with undetectable load – regardless of when you were diagnosed with HIV. Therefore, if you are thinking about pregnancy, do not neglect a visit to the doctor.
Cover: Olya Yogide/Lifehacker
