HIV/AIDS is the most feared of all the sexually transmitted diseases. As the name suggests, the disease is transmitted, in a majority of cases, through unsafe sexual practices. Transmission also happens when one is transfused with infected blood or has used infected needles, but the most saddening way HIV gets transmitted is from a pregnant mother to her unborn child!
HIV among children is a devastating reality now. Most mothers do not themselves know that they may be infected with the disease at the time of their pregnancy. Often times it is the child who falls ill due to the decreasing immunity caused by HIV. The child getting tested positive leads to the detection of HIV in the parents, and at times, the sibling too.
What is heartening here is that HIV transmission from mother to child can be prevented! All it takes is for the mother to take medicines during her pregnancy and when she is feeding her child. The key here is to know whether the mother is infected or not.
The Government of India has taken positive encouraging steps in this direction. It is now mandatory for every pregnant woman to undergo HIV testing as part of her antenatal blood tests. Steps are being taken to make the testing mandatory in the third trimester too, as a lot of negative results in the first trimester could be due to the ‘window period’ of the HIV infection.
This method is indeed commendable as the number of infants born over the years with HIV has steadily decreased.
3.4 million children over the world are infected with HIV yearly! HIV transmission from mother to child can be prevented and there is a desperate need for dedicated work in this field to realize our dream of an AIDS-free generation!
What needs to be done once a pregnant lady is detected positive?
The first thing to be done is not to panic. Though it has been established that the mother is positive, it does not in any way conclude that the unborn child will be positive too!
The next step is to assess the advancement of disease in the lady. AIDS is a slowly progressing disease and can take almost 10 years on an average to progress to the AIDS stage. The infected patient too remains symptomless until the person reaches the end stage.
Medicines are usually started at a stage where it is not too late. This stage is assessed by getting a blood count for CD4 cells done. The CD4 cells are the fighter cells that get attacked by the virus. The steady decrease in the number of these cells is what leads to the development of various diseases.
The count of these cells that is normally around 800-1000 falls gradually and when it reaches around 350-400, the medications are started. Starting medications at this stage helps control the course of the disease in a better way.
So if the pregnant lady’s CD4 count is below the threshold for starting medicines, anti-retroviral medicines are started for her. These medicines will have to be continued through her lifetime.
If the disease is a recent one and has not progressed much, i.e., the CD4 count is well above the threshold, the lady would need to take medicines only to prevent the transmission of her infection to her baby. These medicines will have to be taken during the time she is pregnant, during delivery, and during breastfeeding her baby. Later on, as and when her CD4 levels reach the threshold levels, she will have to take medicines for herself too. The baby upon being born receives anti-retroviral medicines too.
Breastfeeding by an HIV positive mother
Breast milk is a rich source of the viruses and breastfeeding the child is definitely risky. On a brighter side, there are ways to prevent transmission by this method too. The medicines that the mother was taking during pregnancy will have to be continued during the time she breastfeeds too. The medicines can be stopped after a week from the day the breast feeding was stopped.
The baby too receives medicines till the entire time he/she is 6 weeks of age.
The mother can choose not to breast feed too. In such cases, she can stop taking the medicines prescribed to her once she has delivered the baby. The baby continues his/her medicines till 4 to 6 weeks of age.
Treatment of HIV/AIDS in children
In children, the treatment guidelines vary. Since the immunity in children is not well developed, the disease tends to progress rapidly in them. Without treatment, 50% of the infected infants will die before they reach their second birthdays!
Hence medicines are started as early as possible, irrespective of the CD4 cell count.
Anti-retroviral medicines are lifesavers for patients of HIV/AIDS. The better understanding of the virus, the invention of newer and better drugs have made HIV a disease that is not so dreaded as it was a few decades ago.
HIV transmission control in adults is more of a self-awareness procedure. Unless the individual takes responsibility of his/her actions, controlling the spread of the disease is limited.
HIV transmission in children is a possibility though. Through the dedicated efforts of the government and various organizations working in the prevention of mother-to-child transmission of HIV, we will indeed have a day when no pregnant and HIV positive mother delivers a HIV positive baby.
