HIV analysis during pregnancy: diagnosis and interpretation. HIV infection in pregnant women

HIV and pregnancy are combinations that are dangerous for both the mother and the unborn child, for the reason that the disease is transmitted in 40% of cases in the later stages or during labor. But with appropriate preventive actions and corrective therapy, the risk of intrauterine infection is significantly reduced.

What is HIV?

Today, more than 41 million people worldwide are diagnosed with HIV. Modern scientific achievements in the field of pharmaceuticals have made it possible to push back the last stage of the disease - AIDS, as much as possible, which significantly affects the life expectancy of patients.

HIV infection, when it enters the circulatory system, begins an attack on T-lymphocytes, which are responsible for recognizing foreign cells, various viruses and bacteria. There are CD-4 molecules on the surface of lymphocytes, and when they meet with HIV cells, they begin to attack, but as a result, a fusion occurs, the infection changes the genetic material, which leads to a gradual replacement of T-lymphocytes. Thus, without appropriate treatment, the human immune system cannot resist the simplest virus, the disease goes into the stage of AIDS.

In the course of many studies and tests, it was found that the HIV molecule is not able to live long in the air, therefore, infection is possible only through blood, through sexual contact, during pregnancy (from mother to child) or during the birth of a child.

HIV symptoms during pregnancy

Once infected, HIV in the blood can behave differently. More than 60% of people are asymptomatic, but there are about 5% of patients who develop AIDS within a year. But the disease always has several stages:

incubation period (from a couple of months to 5 years);
acute stage;
latent stage;
persistent generalized lymphadenopathy;
AIDS.

Depending on the stage of the course of the disease, symptoms are also distinguished. Initially, the infection may not have any special signs, only after a few months women develop symptoms similar to a cold (fever, swollen lymph nodes, sore throat and diarrhea).

Such symptoms are rarely paid attention to, especially after conception, when the body is rebuilt, and the immune system significantly reduces its functionality. Therefore, an HIV test during pregnancy is mandatory, blood is taken twice - when contacting a antenatal clinic and at the 30th week of gestation in order to exclude false results.

Causes of a false positive HIV test during pregnancy

Diagnosis of infection during pregnancy is carried out by taking blood from a vein at the elbow, the duration of the study is from 1.5 to 2 weeks. If the initial HIV tests are positive, then a second blood test will be required to prevent incorrect results. If the analysis is negative, then no additional tests are needed.

False positive results are not uncommon, especially during pregnancy. At the stage of 9 months of gestation in the mother's body, in some cases, antibodies can be produced that perceive the fetus as a foreign organ. This situation is due to the fact that the growing organism inside the womb has a completely different DNA, which leads to the fact that the HIV test is positive.

An error in diagnosis is possible if the woman does not have her first birth or if she is a blood donor, as well as in the presence of the following pathologies:

the active phase of herpes, influenza or tuberculosis;
diseases of the blood coagulation system (increased or decreased);
the formation of malignant or benign tumors;
infectious lesions of the respiratory tract;
vascular pathology;
development of arthritis or sclerosis.

Also, a false-positive HIV test may be due to the human factor and the error in the blood test. In connection with such situations, the examination is always repeated for a more thorough examination.

How does HIV affect pregnancy?

Confirmation of HIV during pregnancy in a married couple involves the use of certain therapy. If the disease is detected at an early stage, then complications and consequences for the fetus during childbirth will be minimal.

The virus is able to penetrate the bloodstream through the placental barrier to the baby only in case of damage or inflammation of the placenta, so the protective function of this organ will be significantly reduced. Therefore, it is necessary to maintain immunity so that the system can fully perform its protective function.

The risk of transmitting the virus to the fetus increases with a high titer (amount of virus) in the mother in the last months or during labor, when it becomes necessary to intensify labor.

Pregnancy from an HIV-infected man at the present stage of development of medicine is also possible, but the maximum degree of protection must be observed. After a husband has been tested for HIV, he should undergo a six-month course of treatment to improve his immune status. Then the woman must calculate the day of ovulation for subsequent safe conception, and subsequent sexual intercourse between spouses involves only safe sex.

HIV and pregnancy: how to have a healthy baby

In order to give birth to a child without pathologies, an HIV-infected woman is prescribed treatment with antiretroviral drugs. When the diagnosis is confirmed in the LCD (antenatal clinic), then therapy is always discussed with doctors. Tritherapy is mainly used, which involves the use of a combination of three different drugs, which is considered the most effective and reduces the risk of infection of the fetus to almost 0%.

Whatever delivery is chosen, there is always a risk of infection of the child under the influence of the mother's blood and vaginal secretions. Therefore, medical specialists monitor the health of a newborn baby up to a year and a half.

Also, HIV-positive women are prohibited from breastfeeding the baby, as the likelihood of transmitting the virus during lactation increases several times. In general, the possibility of giving birth to a healthy child is very high, subject to competent therapy.

This is a chronic progressive infectious disease caused by a pathogen from the group of retroviruses and occurred before the conception of a child or during the gestational period. A long time passes latently. In the primary reaction, it is manifested by hyperthermia, skin rash, mucosal lesions, transient enlargement of the lymph nodes, and diarrhea. Subsequently, generalized lymphadenopathy occurs, weight gradually decreases, and HIV-associated disorders develop. Diagnosed by laboratory methods (ELISA, PCR, cellular immunity study). Antiretroviral therapy is used to treat and prevent vertical transmission.

ICD-10

O98.7 B20-B24

General information

HIV infection is a strict anthroponosis with a parenteral non-transmissible mechanism of infection from an infected person. Over the past 20 years, the number of newly diagnosed infected pregnant women has increased by almost 600 times and exceeded 120 per 100,000 examined. Most women of childbearing age were infected through sexual contact, the proportion of HIV-positive patients with drug addiction does not exceed 3%. Due to the observance of the rules of asepsis, sufficient antiseptic processing of instruments for invasive procedures and effective serological control, it was possible to significantly reduce the incidence of infection as a result of occupational injuries, blood transfusions, due to the use of contaminated instruments and donor materials. In more than 15% of cases, it is not possible to reliably determine the source of the pathogen and the mechanism of infection. The relevance of special support for HIV-infected pregnant women is due to the high risk of infection of the fetus in the absence of adequate restraining treatment.

Causes

The causative agent of the disease is a human immunodeficiency retrovirus of one of two known types - HIV-1 (HIV-1) or HIV-2 (HIV-2), represented by many subtypes. Usually, infection occurs before the onset of pregnancy, less often - at the time or after the conception of a child, during gestation, childbirth, and the postpartum period. The most common route of transmission of an infectious agent in pregnant women is natural (sexual) through the mucous secretion of an infected partner. Infection is possible with the intravenous administration of narcotic drugs, violation of aseptic and antiseptic standards during invasive manipulations, performance of professional duties with the possibility of contact with the blood of a carrier or patient (health workers, paramedics, cosmetologists). During pregnancy, the role of some artificial ways of parenteral infection increases, and they themselves acquire certain specifics:

Blood transfusion infection. With a complicated course of pregnancy, childbirth and the postpartum period, the likelihood of blood loss increases. Treatment regimens for the most severe bleeding involve the introduction of donor blood and preparations derived from it (plasma, erythrocyte mass). HIV infection is possible when using material tested for the virus from an infected donor in case of blood sampling during the so-called seronegative incubation window, which lasts from 1 week to 3-5 months from the moment the virus enters the body.
instrumental infection. Pregnant patients are more likely than non-pregnant patients to undergo invasive diagnostic and therapeutic procedures. To exclude abnormalities in the development of the fetus, amnioscopy, amniocentesis, chorion biopsy, cordocentesis, placentocentesis are used. For diagnostic purposes, endoscopic examinations (laparoscopy) are performed, for therapeutic purposes - suturing of the cervix, fetoscopic and fetal drainage operations. Infection through contaminated instruments is possible during childbirth (when suturing injuries) and during caesarean section.
Transplant transmission of the virus. Possible solutions for couples planning a pregnancy with severe forms of male infertility are insemination with donor sperm or its use for IVF. As in the case of blood transfusions, in such situations there is a risk of infection when using infected material obtained during the seronegative period. Therefore, for prophylactic purposes, it is recommended to use the sperm of donors who have successfully passed an HIV test six months after the donation of the material.

Pathogenesis

The spread of HIV throughout the body occurs with the blood and macrophages, into which the pathogen is initially introduced. The virus has a high tropism for target cells, the membranes of which contain a specific protein receptor CD4 - T-lymphocytes, dendritic lymphocytes, parts of monocytes and B-lymphocytes, resident microphages, eosinophils, cells of the bone marrow, nervous system, intestines, muscles, vascular endothelium, choriontrophoblast of the placenta, possibly spermatozoa. After replication, a new generation of the pathogen leaves the infected cell, destroying it.

Immunodeficiency viruses have the greatest cytotoxic effect on type I T4 lymphocytes, which leads to depletion of the cell population and disruption of immune homeostasis. A progressive decrease in immunity worsens the protective characteristics of the skin and mucous membranes, reduces the effectiveness of inflammatory reactions to the penetration of infectious agents. As a result, in the final stages of the disease, the patient develops opportunistic infections caused by viruses, bacteria, fungi, helminths, protozoal flora, tumors typical of AIDS (non-Hodgkin's lymphomas, Kaposi's sarcoma), autoimmune processes begin, eventually leading to the death of the patient.

Classification

Domestic virologists use in their work the systematization of the stages of HIV infection proposed by V. Pokrovsky. It is based on the criteria of seropositivity, the severity of symptoms, the presence of complications. The proposed classification reflects the gradual development of infection from the moment of infection to the final clinical outcome:

Incubation stage. HIV is present in the human body, it is actively replicating, but antibodies are not detected, there are no signs of an acute infectious process. The duration of seronegative incubation is usually from 3 to 12 weeks, while the patient is contagious.
Early HIV infection. The primary inflammatory response of the body to the spread of the pathogen lasts from 5 to 44 days (in half of the patients - 1-2 weeks). In 10-50% of cases, the infection immediately takes the form of asymptomatic carriage, which is considered a more favorable prognostic sign.
Stage of subclinical manifestations. Virus replication and destruction of CD4 cells lead to a gradual increase in immunodeficiency. A characteristic manifestation is generalized lymphadenopathy. The latent period in HIV infection lasts from 2 to 20 years or more (on average, 6-7 years).
Stage of secondary pathology. The depletion of protective forces is manifested by secondary (opportunistic) infections, oncopathology. The most common AIDS-indicator diseases in Russia are tuberculosis, cytomegalovirus and candidal infections, pneumocystis pneumonia, toxoplasmosis, and Kaposi's sarcoma.
Terminal stage. Against the background of severe immunodeficiency, pronounced cachexia is noted, there is no effect from the therapy used, the course of secondary diseases becomes irreversible. The duration of the final stage of HIV infection before the death of the patient is usually no more than a few months.

Practicing obstetricians and gynecologists often have to provide specialized care to pregnant women who are in the incubation period, at an early stage of HIV infection or its subclinical stage, less often when secondary disorders appear. Understanding the characteristics of the disease at each stage allows you to choose the optimal scheme for managing pregnancy and the most appropriate method of delivery.

HIV symptoms in pregnant women

Since during pregnancy in most patients stage I-III of the disease are determined, pathological clinical signs are absent or look non-specific. During the first three months after infection, 50-90% of those infected have an early acute immune reaction, which is manifested by weakness, slight fever, urticarial, petechial, papular rash, inflammation of the mucous membranes of the nasopharynx, vagina. Some pregnant women have swollen lymph nodes and develop diarrhea. With a significant decrease in immunity, short-term, mild candidiasis, herpes infection, and other intercurrent diseases may occur.

If HIV infection occurred before pregnancy, and the infection has developed to the stage of latent subclinical manifestations, the only sign of the infectious process is persistent generalized lymphadenopathy. A pregnant woman has at least two lymph nodes with a diameter of 1.0 cm or more, located in two or more groups that are not interconnected. When touched, the affected lymph nodes are elastic, painless, not connected to the surrounding tissues, the skin over them has an unchanged appearance. The increase in nodes persists for 3 months or more. Symptoms of secondary pathology associated with HIV infection are rarely detected in pregnant women.

Complications

The most serious consequence of pregnancy in an HIV-infected woman is perinatal (vertical) infection of the fetus. Without adequate restraining therapy, the probability of infection of the child reaches 30-60%. In 25-30% of cases, the immunodeficiency virus passes from mother to child through the placenta, in 70-75% - during childbirth when passing through an infected birth canal, in 5-20% - through breast milk. HIV infection in 80% of perinatally infected children develops rapidly, and AIDS symptoms appear within 5 years. The most characteristic signs of the disease are malnutrition, persistent diarrhea, lymphadenopathy, hepatosplenomegaly, developmental delay.

Intrauterine infection often leads to damage to the nervous system - diffuse encephalopathy, microcephaly, cerebellar atrophy, deposition of intracranial calcifications. The likelihood of perinatal infection increases with acute manifestations of HIV infection with high viremia, a significant deficiency of T-helpers, extragenital diseases of the mother (diabetes mellitus, cardiopathology, kidney disease), the presence of sexually transmitted infections in a pregnant woman, chorioamnionitis. According to obstetrics specialists, HIV-infected patients are more likely to have a threatened miscarriage, miscarriages, premature births, and perinatal mortality increases.

Diagnostics

Taking into account the potential danger of the patient's HIV status for the unborn child and attending medical personnel, the test for the immunodeficiency virus is included in the list of recommended routine examinations during pregnancy. The main tasks of the diagnostic stage are to identify possible infection and determine the stage of the disease, the nature of its course, and prognosis. For diagnosis, the most informative laboratory methods of research:

Linked immunosorbent assay. Used for screening. Allows you to detect antibodies to the human immunodeficiency virus in the blood serum of a pregnant woman. Negative in the seronegative period. It is considered a method of preliminary diagnosis, it requires confirmation of the specificity of the results.
immune blotting. The method is a kind of ELISA, which makes it possible to determine in the serum antibodies to certain antigenic components of the pathogen, distributed by molecular weight by phoresis. It is a positive immunoblot result that is a reliable sign of the presence of HIV infection in a pregnant woman.
PCR diagnostics. Polymerase chain reaction is considered a method of early detection of the pathogen with a period of infection of 11-15 days. With its help, viral particles are determined in the patient's serum. The reliability of the technique reaches 80%. Its advantage is the possibility of quantitative control of copies of HIV RNA in the blood.
Study of the main subpopulations of lymphocytes. The probable development of immunosuppression is evidenced by a decrease in the level of CD4-lymphocytes (T-helpers) to 500/µl or less. The immunoregulatory index, which reflects the ratio between T-helpers and T-suppressors (CD8-lymphocytes), is less than 1.8.

When a previously unexamined pregnant woman from marginal contingents is admitted for delivery, it is possible to conduct an express HIV test using highly sensitive immunochromatographic test systems. For a planned instrumental examination of an infected patient, non-invasive diagnostic methods are preferred (transabdominal ultrasound, dopplerography of the uteroplacental blood flow, cardiotocography). Differential diagnosis at the stage of early reaction is carried out with ARVI, infectious mononucleosis, diphtheria, rubella, and other acute infections. If generalized lymphadenopathy is detected, it is necessary to exclude hyperthyroidism, brucellosis, viral hepatitis, syphilis, tularemia, amyloidosis, lupus erythematosus, rheumatoid arthritis, lymphoma, and other systemic and oncological diseases. According to the indications, the patient is consulted by an infectious disease specialist, a dermatologist, an oncologist, an endocrinologist, a rheumatologist, a hematologist.

Treatment of HIV infection in pregnant women

The main tasks of pregnancy management in case of infection with the human immunodeficiency virus are infection suppression, correction of clinical manifestations, and prevention of infection of the child. Depending on the severity of symptoms and the stage of the disease, massive polytropic therapy with antiretroviral drugs is prescribed - nucleoside and non-nucleoside reverse transcriptase inhibitors, protease inhibitors, integrase inhibitors. Recommended treatment regimens differ at different gestational ages:

When planning a pregnancy. To avoid embryotoxic effects, women with HIV-positive status should stop taking special drugs before the onset of a fertile ovulatory cycle. In this case, it is possible to completely eliminate the teratogenic effect in the early stages of embryogenesis.
Up to 13 weeks pregnant. Antiretroviral drugs are used in the presence of secondary diseases, a viral load exceeding 100 thousand copies of RNA / ml, a decrease in the concentration of T-helpers less than 100 / μl. In other cases, pharmacotherapy is recommended to be discontinued to exclude negative effects on the fetus.
13 to 28 weeks. When diagnosing HIV infection in the second trimester or when an infected patient is treated at this time, active retroviral therapy is urgently prescribed with a combination of three drugs - two nucleoside reverse transcriptase inhibitors and one drug from other groups.
From 28 weeks to delivery. Antiretroviral treatment continues, chemoprevention of the transmission of the virus from a woman to a child is being carried out. The most popular scheme is in which, from the beginning of the 28th week, the pregnant woman constantly takes zidovudine, and once before childbirth - nevirapine. In some cases, backup schemes are used.

The preferred method of delivery for a pregnant woman diagnosed with HIV infection is vaginal delivery. When they are carried out, it is necessary to exclude any manipulations that violate the integrity of tissues - amniotomy, episiotomy, obstetric forceps, use of a vacuum extractor. Due to a significant increase in the risk of infection of the child, the use of drugs that cause and enhance labor activity is prohibited. A caesarean section is performed after 38 weeks' gestation for unknown viral load, viral load greater than 1,000 copies/mL, no antenatal antiretroviral therapy, and inability to administer retrovir during labor. In the postpartum period, the patient continues to take the recommended antiviral drugs. Since breastfeeding is prohibited, lactation is suppressed with medication.

Forecast and prevention

Adequate prevention of HIV transmission from pregnant woman to fetus can reduce the level of perinatal infection to 8% or less. In economically developed countries, this figure does not exceed 1-2%. Primary prevention of infection involves the use of barrier contraceptives, sexual life with a permanent verified partner, refusal to use injecting drugs, the use of sterile instruments when performing invasive procedures, and careful control of donor materials. To prevent infection of the fetus, it is important to timely register an HIV-infected pregnant woman with a antenatal clinic, refuse invasive prenatal diagnostics, choose the optimal antiretroviral treatment regimen and method of delivery, and prohibit breastfeeding.

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Questions and answers on: testing for HIV during pregnancy

2010-10-13 00:24:37

Julia asks:

I beg you, please answer my question: the first HIV test during pregnancy is negative, my husband’s is negative, my last extramarital affair was more than four years ago ... and the partner’s status is unknown ... the question is this: second, third, fourth once passed for VMC and FA stubbornly shows positive .... And several of these times also hepatitis C is positive .... (the latter is really negative (this despite the fact that the PCSH says that hepatitis C has been detected) What is it? Maybe whether despite the fact that the FA shows positive three times in a row to be a reaction to "foreign protein", pregnancy?Or would it show in different ways?

Responsible Silko Yaroslav Gennadievich:

PCR for hepatitis C indicates that the virus is present in the blood at the moment, although the ELISA for hepatitis may be negative, since there are not enough antibodies or they have not yet been detected. The presence of a negative HIV test, and then a positive one, may indicate that that you were infected during pregnancy or that it is a false positive (which is very rare in pregnancy). During pregnancy, you could only become infected through sexual contact, through drug use, transfusion of infected blood. In any case, you need to contact the regional AIDS center, where you should take the viral load for HIV (this will show if there is a virus and its amount). And my husband must repeat the HIV test now at the AIDS center and in a month (if the result is negative).

2014-04-04 11:19:27

Julia asks:

My husband and I were tested for HIV 3.5 years ago: when we arrived for the result, I had negative, but my husband was not immediately told the answer, but only after 2 days, it turned out to be positive. He got depressed, binge drinking, etc. He refuses to give up again. And she's afraid to have a baby. He is my doctor, he says that due to problems with the liver (he has such), there may be a positive result. What to do? Can I refuse to donate blood for HIV during pregnancy and when the child is born, to him?

Responsible Gritsko Marta Igorevna:

Yes, you can refuse to be tested for HIV. I would advise my husband to retake the analysis, he could be false positive. Was the husband in contact with HIV-infected by occupation?

2015-12-01 07:40:38

Natalia asks:

Hello! I am 25 years old. In October 2014, the erosion was cauterized with a laser. To determine the cause, she took tests for hormones, torch, rubella, HIV, and a biopsy. Everything is okay. I had a miscarriage at 6 weeks in May 2015. (It turned out to get pregnant for the 4th cycle). After a miscarriage and cleansing, she took 3 months approx. We are planning again. In August 2015, she was diagnosed with simple leukoplakia (biopsy confirmed). Passed for 21 types of HPV - nothing was found. Re-passed torch - everything is clean. The doctor insists on treatment with proteflazid and mandatory laser cauterization before pregnancy. Another doctor says that you should not touch the neck in any case before pregnancy! On the Internet, they write a lot about the fact that you can get pregnant and be observed, and cauterize after childbirth. How do you see this situation? Should I cauterize leukoplakia or wait for pregnancy and childbirth? If I cauterize, will there be complications during pregnancy and childbirth? Should I take proteflazid? (If HPV is negative). I really want to hear your opinion! Thank you

Responsible Palyga Igor Evgenievich:

Hello, Natalia! I can say one thing for sure - you do not need proteflazid, what exactly are you going to treat with it? Leukoplakia? From taking this drug, it definitely will not disappear. Regarding the state of the cervix, it is virtually impossible to draw conclusions, it is necessary to see the picture and the conclusion of colposcopy and biopsy. Theoretically, if the histology confirmed the presence of leukoplakia, then it is recommended to cauterize it before pregnancy. With an adequately performed manipulation, there should not be any complications in the future, you are not offered conization.

2015-01-28 12:36:20

Laura asks:

Why can a false-positive result be obtained from a blood test for HIV if a woman does not know that she is pregnant How can blood tests be similar during pregnancy and HIV?

2014-12-16 17:40:15

Victoria asks:

Hello! Tell me if the HIV test could not have been correct if I took it for a year during pregnancy, I was in the hospital with the baby, and my husband passed HIV + no contacts on the side a year later. Could his analysis be false positive, if he has a diseased liver.

Responsible Sukhov Yuri Alexandrovich:

Hello Victoria. The study of blood serum for HIV by ELISA is a preliminary procedure, this is the first stage of an HIV test. Regards, Yusukhov.

2014-12-04 09:06:22

Tatyana asks:

Hello, such a situation, I gave birth to a child, passed tests during pregnancy like everyone else, and a year later I found out that my husband had 6 years as HIV, tell me how can I and the child be healthy? I can't find my place. Thank you

Responsible Yanchenko Vitaly Igorevich:

Hello Tatiana! You need to be tested anonymously in special HIV centers. You can find out about this by calling the helpline, which you can find on the Internet for your region. Good luck to you!

2014-10-15 07:11:58

Alina asks:

Hello, I took tests during pregnancy at 22 weeks, and here is the result, the doctor sent me to an infectious disease specialist without explaining what was wrong with me .... Blood for HIV is negative ...
Bil-15.1
Glu-4.37
Oh, bel-80.0
Creat-54
B;L-5.4
ALT-26
ACE-21
Urea-2.0
Creatinine-46.0
Glucose-4.62
Cholesterol-3.92
PTV-10.9
INR-1.00
fibrinogen-4.5
APTT-26.8
D-DIMER-266.00
Percentage of activity on quick-109.0
Please tell me what's wrong with me????

Responsible Zaitsev Igor Anatolievich:

Hello Alina. The tests that I see are normal, so I think that the reason for referral to an infectious disease specialist is some other. Ask your doctor or infectious disease specialist if you have already been there.

2014-09-07 18:27:00

Tanya asks:

Good evening! please tell me, my husband had HIV, he died in 2012 ... I didn’t know about the disease until it started to progress (I stopped taking pills), we didn’t use protection. we had a healthy daughter in 2010, he knew that there was a chance of getting pregnant and getting sick, he didn’t use a condom, and I had no idea that he was sick! me or my daughter...! can, after some time, get out of me or the child ...?
I got married, is it possible that there is still a child, can it get out during pregnancy?
Is there a chance that the unborn child will manifest? can I safely give birth and not worry that the current husband, daughter and our unborn child are safe?
What do i do?
two days after birth, my daughters were tested for HIV, it was negative ... (I can’t understand now whether my husband asked or it was necessary, she gave birth in an ordinary maternity hospital)!
thanks in advance for your reply

Responsible Sukhov Yuri Alexandrovich:

Hello Tanya. You really have a lot of questions, but few concrete research results. You don't need to worry, you just need to look into it. Taking into account the timing, with a probability of 99.9, after an appropriate examination, it is possible to clarify your condition and give recommendations. And yet, keep in mind that chronic stress (like you are now!) Reduces immunity! Contact. Regards, Yu Sukhov.

2014-06-10 11:30:38

Sveta asks:

My period is 11 days late. The tests are negative. During the examination, they say that the pregnancy is 5-6 weeks. Diagnose trichomoniasis. Refers to tests for HIV, syphilis and cancer cells. What should I do? Get crazy. Help.

Responsible Wild Nadezhda Ivanovna:

During pregnancy and when registering for pregnancy, these tests are taken twice, so I recommend calming down and donating an.blood for RV, HIV. For a cytological examination of a smear, i.e. a smear for "cancer cells" is taken from all women who are examined by a gynecologist. Ultrasound is required to confirm pregnancy.

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Ways of transmission of infection

1. Natural: contact (mainly sexual in all types of sexual contact) and vertical (from mother to fetus through blood).

2. Artificial:

Artifical non-medical (use of contaminated instruments for manicure, pedicure, piercing, tattooing; use of a common syringe for intravenous drug injection);

Artificial medical (virus exposure as a result of tissue and organ transplantation, transfusion of blood and plasma components, use of donor sperm).

Diagnosis for HIV during pregnancy:

1. Determination of antibodies to HIV by ELISA performed three times during pregnancy (at registration, at 30 weeks and at 36 weeks). If a positive result is obtained for the first time, then blotting is carried out.

HIV testing is always carried out with the patient's consent; recently, some centers allocate a quota for a single HIV test of the child's father.

Initially, pre-test counseling is carried out, an infectious and sexual history is collected, the presence, nature and length of bad habits and intoxications are ascertained. You should not be offended by an obstetrician - gynecologist for seemingly inappropriate questions about intravenous drugs and the number of sexual partners, about alcohol and smoking. All of this information helps you determine your obstetric risk, and it's not just about HIV infection. They will also tell you what HIV infection is, how it threatens a person, how it is transmitted and how infection can be prevented, what results can be and in what time frame. You may have read and are aware of the main aspects of this problem (we hope so), but listen to the doctor and you may have new questions that you would like to ask. Don't treat pre-test counseling as a formality.

Post-test counseling is carried out in case of a positive result for HIV. All the same information is repeated as in pre-test counseling, because now this information is no longer introductory, but practical. Then it explains in detail the impact of HIV infection on pregnancy, the risk of transmission to the fetus and how to minimize it, how to live with such a disease, what to treat and where to go in certain cases.

The patient should be consulted by an infectious disease specialist of the AIDS center (inpatient or outpatient, it depends on the obstetric situation) and registered. Without an account, it is impossible to get antiretroviral therapy drugs, they are given at a discount, and few people can afford to buy them on their own. The price of drugs ranges from about 3,000 to 40,000 thousand rubles per drug, and, as a rule, a patient receives from two to five types of drugs.

2. Immune and linear blotting is a highly sensitive method of research to confirm or refute the diagnosis of HIV infection. This method is used if a doubtful or positive result for antibodies to HIV has come. In this case (if the blood is taken at the second stage of the study), the result “HIV delayed” is sent to the antenatal clinic.

3. Determination of the immune status.

Immune status is the number of CD4+ T cells in a cubic millimeter of blood. These are protective cells of the lymphocytic system, their number reflects the degree of infection of the immune system, the depth of the infectious process. Depending on the number of CD4+ T cells, the activity of antiretroviral therapy is selected.

In a healthy person, the number of CD4+ T cells is in the range of 600 - 1900 cells/ml of blood. Immediately after infection (after 1-3 weeks), the level of cells can drop sharply (but we rarely see a patient at this stage), then the body begins to resist and the number of lymphocytes increases, but no longer reaches the initial level. Thereafter, the level of CD4+ T cells gradually decreases by about 50 cells/ml per year. For a long time, the body can resist HIV infection on its own, but with the onset of pregnancy, the situation changes, here the prescription of approved antiretroviral drugs is made to all women without exception.

4. Determination of viral load. Viral load reflects the number of copies of the viral RNA (genetic basis) that circulates in the blood. The higher this indicator, the more dangerous the course of the disease, the faster the damage to the immune system and the higher the risk of transmission by any route. An indicator of less than 10,000 copies per µl is considered a low viral load, and more than 100,000 copies/µl is considered a high viral load.

5. Express testing for HIV. This type of study is performed if a woman enters the maternity hospital unexamined, and there is no time to wait for the results of an ELISA for HIV (an emergency requiring delivery). In such a situation, blood is taken for analysis by ELISA and express testing at the same time. The final diagnosis of "HIV infection" according to the result of the express test cannot be set. But a positive or doubtful result of such an emergency analysis already serves as an indication for HIV chemoprophylaxis during childbirth and the appointment of antiretroviral prophylaxis for the child on the first day (syrup). The likely toxic effect of a chemotherapy drug is not comparable to the possible prevention of the transmission of HIV infection to a baby. Then, within 1 - 2 days, the result of the ELISA comes, depending on the result, an additional examination is carried out, consultation by the infectious disease specialist of the AIDS center.

Planning for pregnancy with HIV

The realization of her childbearing function is the right of every woman, no matter how others treat it. But in the case of HIV infection, a planned pregnancy is practically the only chance to give birth to a healthy baby and not transmit the virus to him. There are also families where only one of the spouses is infected. Next, we will describe how conception is carried out in these cases.

1. Both spouses are infected.

Complete examination of the couple for significant infections. Tests for hepatitis B and C, microreaction for syphilis, tests for STIs (gonorrhea, chlamydia, trichomoniasis, ureaplasma, mycoplasma), herpes viruses, cytomegalovirus and Epstein-Barr virus should be taken. All identified diseases should be treated as fully as possible, as this reduces the risk of intrauterine infection of the fetus.

General examination (general blood and urine tests, biochemical blood test, fluorography, consultations of specialists according to indications).

Consultation with an AIDS center infectious disease specialist and timely administration of highly active antiretroviral therapy (HAART) to both partners. This is necessary to reduce the viral load and protect partners as much as possible, as they can be infected with early types of the virus. In addition, getting into the human body, the virus inevitably mutates.

2. The wife is infected, the husband is healthy.

This situation is the most "simple" for doctors in terms of safe conception, since unprotected sexual contact is not required, but with great risks for the unborn child.

You should also conduct a general examination and specific tests for infections, treat identified infections.

A woman needs to consult an infectious disease specialist at the AIDS Center, if she is not yet registered, then register, report a planned pregnancy and receive antiretroviral therapy.

The safest method of conception is artificial insemination. This is a method in which during the period of ovulation (on the 12th - 15th day of the menstrual cycle), the partner's sperm is artificially injected into the woman's vagina.

3. The husband is infected, the wife is healthy.

It is much easier for a woman to get HIV infection through contact with an infected man than for a man in the same conditions. This is because the contact of semen and the vaginal mucosa is much longer than the contact of the skin and penile mucosa with vaginal secretions. For this reason, natural conception in this situation is associated with a high risk of infection, and the more attempts, the higher the likelihood.

The general examination and treatment is the same as in the previous cases.

The preferred method of conception is the introduction of purified sperm into the woman's vagina on the days of ovulation. Few people know that the spermatozoa themselves cannot be infected with the immunodeficiency virus, but the seminal fluid surrounding them, on the contrary, carries a very high viral load. If purified semen is introduced, then the risk of infection is minimal (the virus content during purification can be reduced to 95%). This method is preferred for couples with the indicated infectious history.

In some cases, in vitro fertilization methods (IVF, ICSI) are used. As a rule, these methods are used if there is also a pathology of the partner's sperm (azoospermia, asthenozoospermia, and others) or other forms of infertility.

Management of pregnancy with HIV

1. How does pregnancy affect HIV infection?

Pregnancy is a state of natural immunosuppression due to high levels of progesterone (a hormone that maintains pregnancy). Some suppression of the immune system is necessary so that the mother's body does not reject the fetus's body, since the child is an independent organism that half inherits the father's genetic material, which means it is alien.

In the absence of antiretroviral therapy, HIV during pregnancy can progress, from a latent stage to a stage with complications, which threatens not only health, but also life.

With timely treatment, there is no significant dynamics in the development of HIV infection. According to some reports, after childbirth, the state of immunity even improves, but they don’t know how to explain this yet, but there are such data.

During pregnancy, a woman living with HIV is seen by two obstetrician-gynecologists. The obstetrician-gynecologist of the antenatal clinic carries out general management of pregnancy, prescribes an examination in accordance with order No. 572 and treatment of obstetric pathology (threat of abortion, nausea and vomiting of pregnant women, preeclampsia, and others).

The obstetrician-gynecologist of the AIDS Center examines the patient at least three times during pregnancy. Here, an obstetric examination is combined with data on the immune status and viral load, based on a combination of examinations, management and treatment tactics are developed, it is possible to change antiretroviral therapy or add another drug to the regimen. At the last visit in the period of 34-36 weeks, the patient is given not only a medical opinion, but also a drug for HIV chemoprophylaxis during childbirth (intravenous administration), as well as a drug for HIV chemoprophylaxis for a child in the form of a syrup. Also, a woman is given a detailed scheme for the use of both forms of drugs.

2. How does HIV infection affect pregnancy?

Of course, first of all, we are interested in the risk of transmitting the virus to the child. Other complications of pregnancy are rarely directly related to HIV infection. Infection does not directly affect the ability to become pregnant.

Without chemoprophylaxis of HIV infection, the risk of transmission of the virus from mother to fetus is from 10% to 50%. The virus can be transmitted in several ways:

1. Infection during pregnancy.
2. Infection during childbirth.
3. Infection during breastfeeding.

The percentage of types of infection of the child is shown in the figure.

There are many aspects and risks in this issue that determine the outcome of pregnancy with HIV.

Maternal aspects:

Viral load (the higher the viral load, the higher the risk of passing HIV to the child);

Immune status (the lower the number of CD4 + T cells, the less protected the mother's body and the higher the risk of any bacterial, viral and fungal complications that cannot affect the child);

Associated diseases and bad habits.

All chronic diseases (especially inflammatory ones) reduce immunity to some extent. Your doctor is especially interested in the presence of hepatitis B and C (which is not uncommon in women who have injected drugs in the past or who have had sexual contact with a drug user), STIs (syphilis, gonorrhea, chlamydia, trichomoniasis and others), as well as bad habits (alcohol, smoking, drugs and psychoactive substances in the past or at the moment). Drugs are the risk of direct intravenous infection with a number of infections, as well as the formation of severe complications, from infective endocarditis to sepsis. Alcohol is a strong factor in the formation of immunodeficiency in itself, and in combination with an existing HIV infection, it significantly worsens the prognosis.

Obstetric - gynecological aspects during pregnancy:

Sometimes there is a need for invasive diagnostics during pregnancy (amniocentesis - amniotic fluid sampling, cordocentesis - blood sampling from the umbilical vein), if for a healthy woman these activities are carried out with minimal risk (less than 1% of spontaneous miscarriages and leakage of amniotic fluid), then for an infected woman patients, these manipulations can be dangerous, as the possibility of transmitting the virus to the child increases. In the event of such a situation, when a geneticist (or ultrasound doctor) recommends an invasive diagnosis, it is necessary to explain to the patient all the risks (possible birth of a fetus with a genetic syndrome and an increased risk of infection), weigh and make an agreed decision. The patient always makes the final decision.

Pathology of the placenta (chronic fetoplacental insufficiency, placentitis). With many pathologies of the placenta, one of its main functions, the barrier, suffers, thus creating prerequisites for the virus to enter the child's bloodstream. Also, the virus can enter the cells of the placenta and multiply, and then infect the fetus.

During childbirth (more in the article "Childbirth and the postpartum period with HIV infection")

Premature opening of the fetal bladder and outpouring of water,
- rapid childbirth
- protracted labor and anomalies of labor activity,
- Birth trauma.

Risks on the part of the child (for more details, see the article “Childbirth and the postpartum period with HIV infection”):

big fruit,
- prematurity and hypotrophy of the fetus weighing less than 2500 grams,
- the first child of twins,
- intrauterine infection of the fetus with damage to the skin (pemphigus of the newborn, vesiculopustulosis),
- ingestion of amniotic fluid and aspiration (inhalation of amniotic fluid).

Chemoprophylaxis of HIV transmission during pregnancy

For chemoprophylaxis of HIV transmission, drugs from the same range as for basic treatment are used. However, some drugs are contraindicated. They are not prescribed, and if a woman received them before pregnancy, then they are replaced with permitted ones. The list of recommended drugs is prescribed in the Decree of the Government of the Russian Federation dated December 30, 2014 No. 2782-r.

Preparations:

1) HIV protease inhibitors (nelfinavir, atazanavir, ritonavir, darunavir, indinavir, lopinavir + ritonavir is a combination drug, fosamprenavir, saquinavir, telaprevir).

2) Nucleosides and nucleotides (telbivudine, abacavir, phosphazid, didanosine, zidovudine, stavudine, tenofovir, entecavir, lamivudine).

3) Non-nucleoside reverse transcriptase inhibitors (nevirapine, efavirenz, etravirine).

All these drugs are prescribed in a period of 14 weeks (at earlier periods, a teratogenic effect of drugs is possible, that is, provoking congenital malformations of the fetus). HAART (highly active antiretroviral therapy) drugs are started even if HIV infection is detected a few days before delivery, since most cases of prenatal infection occur in the third trimester. Prescribing treatment helps to significantly reduce the viral load almost immediately, which reduces the risk of passing the infection to the child. If the HIV status has been known for a long time and the patient is taking therapy, then it should not be stopped (substitution of drugs is possible). In rare cases, during the first trimester, HAART drugs are stopped (all at the same time).

Side effects and toxic effects of HAART drugs:

Effect on the blood system: anemia (decrease in hemoglobin and erythrocytes), leukopenia (decrease in leukocytes), thrombocytopenia (decrease in blood clotting cells - platelets);

Dyspeptic phenomena (nausea, vomiting, heartburn, pain in the right hypochondrium and epigastrium, loss of appetite and constipation);

Hepatotoxicity (impaired liver function), detected by biochemical blood tests (bilirubins, AlAT, AST, alkaline phosphatase, GGT), in severe cases clinically (jaundice, itching, lightening of feces, darkening of urine and other symptoms);

Dysfunction of the pancreas (pancreatitis), manifested by pain in the left hypochondrium or shingles, nausea, vomiting, fever, diarrhea and changes in tests (increased blood and urine amylase);

Osteoporosis and osteopenia (increased bone fragility) develops, as a rule, with long-term use;

Headaches, weakness, drowsiness;

Allergic reactions (often like urticaria).

Fetal risk of HAART:

The toxic effect on the hematopoietic system is the same as that of the mother.

Babies on HAART tend to be born at a lower weight than the general population and gain weight more slowly early in life. Then the difference levels out and there are no significant differences in physical development.

Previously, the influence of HAART drugs on the formation of the fetal nervous system was discussed, but at the moment it is still concluded that the lag in psychomotor development and neurological symptoms are associated with the use of drugs by the mother. In the absence of a drug history, the indicators of psychomotor development of children from HIV-infected mothers on therapy and other children do not have a significant difference.

The risks of HAART to the fetus are not commensurate with the potential benefits of treatment.

After the start of chemoprophylaxis, the patient is taken under control at the AIDS center, she is invited to consultative visits to assess the effect of the drug, monitor compliance (adherence to treatment, adherence to the prescribed regimen), tolerability and severity of side effects. During the visit, a general examination, a patient interview and laboratory tests are performed (more on them below). After the start of chemoprophylaxis, the first follow-up examination is performed after 2 weeks, and then every 4 weeks until delivery.

KLA is taken every visit, since the most common side effect of HAART drugs (in particular, azidothymidine) is a toxic effect on the hematopoietic system and the development of anemia, thrombocytopenia, granulocytopenia (a decrease in the number of all blood cells).

The CD4+ T cell count is assessed 4, 8, 12 weeks after the start of prophylaxis and 4 weeks before the expected date of delivery. If the number of CD4+ T cells is less than 300 cells/ml, the chemoprevention regimen is revised in favor of more active drugs.

Viral load is controlled after 4, 12 weeks from the start of therapy and 4 weeks before the expected birth. A viral load of 300,000 copies per ml is also an indication for increased therapy. A high viral load detected before childbirth is an additional indication for a caesarean section.

Concomitant treatment

1. Reception of multivitamin complexes for pregnant women (elevit pronatal, vitrum prenatal, femibion natalkea I and II).

2. Iron preparations in the development of anemia (sorbifer, maltofer and others).

3. Hepatoprotectors for signs of toxic liver damage (Essentiale).

HIV infection in a woman of childbearing age is not a contraindication to pregnancy, but a serious and deliberate approach is required. Perhaps there are not many pathologies in which almost everything depends on the well-coordinated work of the patient and doctors. No one guarantees a woman with HIV the birth of a healthy child, but the more a woman is committed to therapy, the more likely it is to bear and give birth to an uninfected child. Pregnancy will be accompanied by taking a large number of different drugs, which is also risky for the fetus, but all this serves a good purpose - the birth of an uninfected baby. Look after yourself and be healthy!

Each expectant mother for 9 months passes a lot of various tests, including an analysis for HIV infection. It's a real shock for a woman to get a positive HIV result during pregnancy. Let's try to figure out why pregnant women can have a positive HIV result in the absence of HIV infection, and what to do if the test gave false results for HIV during pregnancy.

· A cruel joke, or a dubious HIV test during pregnancy

When a doctor informs a pregnant woman in a antenatal clinic that she has a positive HIV test, it's the best thing to fall into hysterics. With her mind, the expectant mother understands that this cannot be, but panic inexorably covers her eyes. And then there is the doctor, at best, with sympathy, and at worst, he looks at the unfortunate woman with suspicion, writing her a referral to the AIDS center. In the head of the future mother, thoughts are swarming that her life is over, every now and then, bumping into indignation about the misfortune that came from nowhere? It seems that she is not a prostitute, not a drug addict, a normal decent woman ... what will happen to the baby, what will happen to her, and how can I even tell my husband about such a thing? It’s good when the future dad is quite an adequate, reasonable person, but even his reaction is difficult to predict ....

Much in this situation depends directly on the delicacy of the doctor and the awareness of the woman. Firstly, even really does not mean at all that it is actually in the blood. Any single HIV test, positive or negative, is questionable. To obtain reliable data, the HIV test must be taken several times. And of course, if a positive HIV result is obtained during pregnancy, you need to take additional tests (if the diagnosis is not confirmed, then this is a false positive result for HIV). And, secondly, a false positive result for HIV in pregnant women is quite common, due to reasons that are quite understandable from a medical point of view.

· Why is there a false positive HIV test during pregnancy?

It turns out that false HIV results during pregnancy are a completely adequate test reaction to some processes that can occur in the body of a healthy pregnant woman. More specifically, the female body can in some cases produce antibodies to the developing fetus. The baby that develops in the mother's womb is a fusion of two genetic materials, a woman and a man, and sometimes the female body can perceive this newly formed and growing DNA as foreign. And then the body's defense mechanism begins to produce antibodies, which affects a positive HIV test during pregnancy.

Often a false-positive result for HIV during pregnancy is obtained in women who have a history of some chronic diseases.

In addition, the notorious “human factor” also explains the false results of HIV during pregnancy - no one has canceled it. Test tubes with blood could simply be mixed up, for example, or the results of a really infected person could be entered into your analysis.

As already mentioned, any single HIV test, whether you are pregnant or not, is questionable. That is why the HIV test should be done several times, especially during pregnancy. In any case, a false positive HIV test during pregnancy is better than a negative result if you have an infection. But let's not talk about sad things.

· Consequences of a false positive result

Of course, doctors are aware that the result of HIV in pregnant women is often false positive, but despite this, they are obliged to act in accordance with the recommendations of the Ministry of Health. In practice, this means that the pregnant woman needs to be re-tested.

At the same time, the specialists of the local AIDS center are unlikely to understand whether you have a false positive result for HIV or a true one. A medical card will be issued immediately, which will indicate that you are being registered with the AIDS Control and Prevention Center. We hasten to reassure you that all your suffering will be limited to the usual blood test, so you should not react to the seriousness of the face of the lady in the registry, looking at you like some kind of leper.

There is nothing to be done, such minor troubles are quite possible if in the first half of your pregnancy a false positive result on an HIV test comes. Where big problems can arise if such a diagnosis is made to a woman immediately before childbirth.

If this happens, the pregnant woman is immediately isolated, without waiting for the results of a second test. The situation in the maternity hospital can be called healthy with a colossal stretch, since the likelihood that the staff will understand, or even think about whether the expectant mother is really HIV-infected, is zero. A woman will have to be patient and courageous in order to survive this time and the upcoming birth, up to and including obtaining "refutative" results. In addition, the mother will not be allowed to breastfeed the newborn, at least until a new, this time negative result comes.

· What should a woman do if she gets a false positive HIV result?

The first and most important thing that a young mother needs to do when reporting her supposedly positive HIV test during pregnancy is to exhale and drive away the panic! The internet is filled with scary stories of women having an abortion or jumping off the roof of a 9-story building after getting a dubious HIV test while pregnant.

Of course, you can’t explain to everyone that such a test can give a false positive result, the doctors themselves speak of a 50% accuracy of such an analysis, and sometimes they behave, to put it mildly, incorrectly. Therefore, a young mother should be resilient. You need to try as calmly as possible in this situation, survive the next week in order to wait for a second result. Time will pass, doubts will dissipate, and experiences may affect your baby. Therefore, your main task is to remain calm, take care of your baby!

Yana Lagidna, especially for the site

And a little more about what affects a positive HIV test during pregnancy: