Editor’s Note: Co-author Zhang Xiayan is a doctor of Shijingshan District CDC in Beijing.
The editor has been a volunteer HIV counseling and testing officer for a long time in the clinical front line, and has also been a HIV medical record manager for a long time. He has been to different hospitals, met many people and heard many stories.
One of them may not be called a story, but an accident. Anyway, I was so impressed by it that many years later today, I cannot forget it:
A young couple, the girl was pregnant and came for a pregnancy test.
Anyone who has had a pregnancy test knows that AIDS and syphilis are items that must be tested.
Originally, it was a joyful thing, but when they got the preliminary screening report, both the couple were dumbfounded: the girl who was going to be a mother was positive for HIV preliminary screening! What is even more bizarre is that the husband’s test is negative!
No matter how the doctor explains, the preliminary screening result is not equal to the diagnosis, and there are reports of false positive preliminary screening results from time to time among pregnant women, which the husband cannot accept.
He disappeared, despite his wife’s frantic search for him.
A week later, the diagnosis report came back, and as expected, it was false positive. The little mother put down the big stone in her heart. However, the once loving couple could never return to the original point.
The relationship between people is sometimes especially untenable. There may be only a line between stories and accidents.
This seems to be a story, but what if the original diagnosis was positive?
How do you determine whether you are infected with HIV?
As just said, all pregnant women will be tested for AIDS, which is as important to babies, mothers and doctors.
To determine whether there is infection, at least two tests must be required: preliminary screening and confirmation.
The preliminary screening test is relatively simple. Its function is to find HIV infection to the greatest extent. Based on this principle, there will be some special circumstances, that is, the preliminary screening is a [positive] test. In fact, it is not a real infection, but a [false positive].
In such a situation, the medical staff will usually draw blood again, conduct a preliminary screening again, and exclude all possible opportunities for mistakes again. If the test is still [positive], the blood sample will be subject to another confirmation test called [gold standard].
Confirmatory tests generally require hospitals to send blood to centers for disease prevention and control around the country for testing. If the confirmed test is also positive, HIV infection is a certainty.
Does Infected Mother Have what Choice?
Once a pregnant mother is found to be infected with HIV, she can choose whether to terminate the pregnancy.
For many infected mothers, if they choose to terminate pregnancy (abortion), they may not have the chance to give birth again in their lives.
However, if the pregnancy is not terminated, it is possible to give birth to a baby infected with HIV and live in disaster at birth. Even if the baby is not infected, the infected mother may die prematurely and cannot take care of the baby to adults.
Therefore, this choice is very difficult and painful for infected mothers.
How to protect the baby to the greatest extent?
There are also many mothers who choose to keep their babies and cherish this opportunity.
Mother-to-child blocking, including a series of comprehensive interventions, can protect infected mothers to the greatest extent and prevent babies from contracting HIV at birth.
Step 1 Take antiviral drugs
Mothers of infected persons who choose to continue pregnancy need free antiviral treatment immediately.
Some prenatal examination hospitals will provide drugs for infected mothers or transfer patients to the Centers for Disease Control and Prevention to ensure that they can take antiviral drugs as soon as possible.
Before and during medication, especially at the beginning of medication and the third trimester of pregnancy, immunity assessment (CD4 + T lymphocyte count), virus detection (load) and other body function tests should be carried out to assess the severity of infection and monitor medication.
Research shows that through standardized administration of antiviral drugs, appropriate delivery management and feeding guidance, the mother-to-child transmission rate of AIDS can be reduced to less than 2%.
2. Reasonable delivery methods
Pregnant women should go to the hospital for delivery as soon as possible.
Although the fetus can also be infected with HIV when it comes into contact with the mother’s blood and vaginal secretions during delivery, cesarean section is not necessary.
Doctors will comprehensively evaluate the condition of the parturient, select the appropriate delivery method, and provide safe midwifery services throughout the process.
3. Reasonable feeding methods
After delivery, maternal and child health care hospitals, designated hospitals or CDC will provide antiviral drugs free of charge, and parturients need to continue taking them.
After the baby is born, whether there is infection or not, it also needs to take antiviral drugs for preventive treatment.
Newborn babies should choose formula milk because HIV virus can enter milk. Eating milk powder can protect the baby from infection to the greatest extent.
However, due to limited conditions, in some extremely poor areas, some infected mothers can only choose breast-feeding to ensure the survival of their children. Of course, the risk of infection borne by the baby will inevitably increase under such circumstances.
However, the most important bottom line is that mixed feeding must be eliminated and human milk must not be eaten together with milk or milk powder. Because mixed feeding is more likely to cause baby diarrhea and digestive tract injury, it is more likely to be infected with the virus.
Conclusion
Mother-to-child transmission of AIDS can occur during pregnancy, during childbirth and during breastfeeding after delivery.
If no intervention strategy is adopted, the transmission rate in utero and during delivery is about 15% ~ 30%, and the risk of HIV infection in breast-fed children is about 20% ~ 45%.
HIV-infected infants usually show clinical symptoms within the first year after birth. Without effective treatment, one third of infected infants die within one year and 50% within two years.
In any case, it is very sad to find AIDS infection during pregnancy. May there be no disease in the world.