Motherhood is a feeling every woman wants to experience. HIV-infected women are no exceptions. Like normal expecting mothers, they too can deliver a baby who is not HIV infected, writes Dr Gaurav Thukral, Head Medical Services, HealthCare at Home; and a master trainer in HIV-AIDS prevention training
Presently, India has 5.7 million people afflicted with HIV/AIDS, as per UNICEF, which further states that around 38 per cent of the total figure are women, who must have given birth to a child in the past or might do so. HIV-infected expecting mothers are always running a risk of transferring the HIV virus to the new-born child.
Going by UNICEF’s figures, around 2,20000 children in India are infected with HIV/AIDS and 50,000 to 60,000 newborns are given birth by HIV/AIDS-afflicted mothers every year in the country. These figures can be troubling enough to take remedial actions to avoid the situation from flaring up to a point where it gets difficult to employ corrective measures.
Apart from what the disease does to HIV/AIDS- infected children, the social stigma that is associated with the disease puts enormous metal burden on children, spoiling their growing up and formative years and making them lead a life of complete isolation and seclusion.
The major challenge is to ascertain whether the mother is HIV-infected or not as the symptoms are asymptomatic. Gynaecologists prescribe mandatory HIV test post first-time antenatal check-up. If the woman is found to be HIV-infected and the viral load is high, delivery is planned accordingly.
There is a myth that children born to women afflicted with HIV are infected as well in 100 per cent of cases. Baseless is the reasoning!
Studies show that only 33 per cent of the babies born to HIV-infected mothers who are not taking ART medicines have HIV. This percentage, the studies say, can be brought down to one per cent if women with HIV begin subscribing to ART medication.
So the claims that HIV-infected women should not bear babies and that all of them born to such women are infected are unfounded.
How newborns get infected?
Newborns mostly get HIV virus from infected mothers at the time of labour. While infections can pass on to the unborn children at any stage of pregnancy, chances are much higher for them to contract the virus during the delivery process.
Risks rises manifold if the delivery takes a long time than usual. The fact that the child comes in direct contact with infected mother’s blood during delivery increases at that stage. If the delivery period is longer, the child is exposed to the infected blood for a much longer time and so the risks are even higher.
Other than delivery, the newborn is susceptible to contract the virus through infected breast milk of the mother, if she is not subscribing to ART medication during the breastfeeding sessions. As per the guidelines of the World Health Organization (WHO), HIV-infected mothers should take ART when they breastfeeding their babies. In some countries like the US breastfeeding is not allowed by HIV-infected mothers, and they are asked to rather go for infant formula instead of their own milk.
Preventing newborns from contracting HIV
Unlike normal expecting mothers, women afflicted with HIV/AIDS run the risk of passing on the virus to their babies. While the fear is genuine and obvious, taking a few measures can cut the risk substantially.
Consultation with HIV specialist: Women already afflicted with HIV virus should consult a specialist before planning a baby. If a woman comes to know that she is suffering from HIV during an antenatal check up, she should immediately consult a specialist. A thorough examination to check the level of HIV in mother’s body can help in better planning and cut chances of the baby contracting the virus. The sessions help understand the pros and cons of pregnancy and dealing with it better. Viral load can be gauged during the examination and accordingly medications and care can be suggested. Women who have suppressed virus have less chance of passing it on to the baby against those whose virus is present in the blood. Thereby, consulting a doctor becomes imperative.
Proper medication: After diagnosis, combination of drugs are prescribed which the women should take religiously. There should be regular meetings with the specialist who keeps altering the course of medicines with the progression of pregnancy. HIV medicines are available free of cost at all government-run hospitals in India.
Delivery of baby: The virus in the blood around delivery determines whether it would be caesarean or vaginal. If the viral load is high or if the mother is not taking medicines, the procedure recommended is always Caesarean so that the baby does not come in contact with mother’s blood and even if the contact is there, it must be as low as it can be. In case the presence of virus is negligible and the mother is properly taking drugs, vaginal delivery is as good to be performed.
Breastfeeding the baby: HIV virus can possibly pass to the baby from HIV-infected mother. So either the mother should refrain from breastfeeding or do so while taking proper antiretroviral (ART) medication. Even though mothers with HIV are on medication, chances in some cases are still there of virus transmission if the viral load in mother is exceedingly high. In developing nations where availability of infant formula is scarce, there is no ban on breastfeeding. However, it is advisable to do so under the guidance of HIV specialist to minimise virus transmission to newborns.
Early diagnosis: It is very important to get the babies tested post delivery for any HIV transmission. Some blood tests are performed to make out the HIV viral load. In India, diagnosis was possible among infants only after the age of 18 months, due to which crucial time was lost and led to late start of treatment and care. However, in 2010 the government rolled out a programme for diagnosis among infants who were less than 18 months.
During 2012-13, 12,169 infants, less than 18 months, born to HIV-infected mothers were tested till December 2012, as per NACO’s Annual Report 2012-13. India is behind Western nations where infants are tested in just a few weeks of birth. So infants should be tested for HIV transmission as soon as they are the prescribed age to get tested in India, without waste of time.
HIV might afflict a woman for any reason. But the fear of HIV transmission should not become a deterrent for becoming pregnant. Just being cautious can help!