Human Immunodeficiency Viruses (HIV)
Description of Infection
There are two Human Immunodeficiency Viruses (HIV). Both occur all over the world and behave in the same way. They cannot survive outside of human cells, and are transmitted by direct contact with blood, by sexual contact, and occasionally by other body fluids.
They are also transmitted from parent to child during pregnancy - called vertical transmission.
With no treatment HIV infection almost always progresses to AIDS (Acquired Immunodeficiency Syndrome) and is always fatal.
Every exposure does not cause infection, and every pregnancy does not pass it to the baby. About 15 percent of them do. It is the uniformly fatal part that makes this disease so important to understand.
Since effective treatment has become available, it is possible for people who keep their treatment going every day of their lives to stay healthy and treat infection with HIV as a chronic disease.
Symptoms
Somewhere between 7 and 11 days after exposure, HIV presents as acute retoviral syndrome causing:
fever,
fatigue,
swollen lymph nodes,
sore throat,
head aches
and rash.
These symptoms last for a short time, and then go away completely.
Between a few months and 8 to 10 years later, once the HIV infection has weakened the immune system beyond a point, HIV returns as:
weight lose,
repeated infections,
and numerous other symptoms associated with the onset of Acquired Immunodeficiency Syndrome (AIDS).
Risk Factors for Exposure
While it is possible for anyone to contract this infection education can help you avoid behaviors that increase risk. These behaviors include:
Sexual intercourse with penetration,
either anal or vaginal
Shared IV needle use
Accidental needle sticks among health professionals
Intrauterine exposure to an HIV positive mother
Prevention
While HIV is a major concern it is also very preventable through the following steps:
Consistent condom use
Testing of everyone between 13 and 65 annually and pregnant people in the first and last trimesters
Education on safe personal health practices in their own languages
Availability of clean needles, non-punative substance abuse treatment, and comprehensive prenatal care for everyone
Testing
In pregnancy, HIV testing is one of the blood tests included in initial prenatal lab work. The usual test is one that screens for both HIV 1 and HIV 2 viruses, and if either test is positive a different confirmatory test that can diagnose is done before results are returned to the practitioner. The test is usually repeated in the third trimester.
At other times, people can usually get tested at places such as the health department or Planned Parenthood, and the test should be included in well person exams at the doctor or midwife's office.
If a person has HIV additional tests are used to measure the amount of virus present and the number of a particular type of T cells (the CD4 cells) that are present as a means of monitoring the disease and its treatment.
Treatment
HIV infection is treated by infectious disease specialists. It requires ongoing monitoring with blood work, various other types of tests, and daily medication with changing combinations of medications.
If a person is treated promptly and continues their treatment without interruption to maintain an undetectable viral load and a healthy CD4 count, they can live with HIV as a chronic condition for a very long time. They can also have a healthy pregnancy and a vaginal delivery.
There are further issues about pregnancy and birth and with the ongoing relationship in general, between partners with differing HIV status. Depending upon which partner is positive, there is preventive treatment available for the negative exposed partner, and there are various other strategies to consider.
A parent with an undetectable viral load, who has been on full antiretroviral therapy throughout pregnancy, has almost no chance of transmitting HIV vertically to the baby. However, breastfeeding is still discouraged in developed countries because of fear of transmission through breast milk, although most of the research on this topic has been done with populations in less developed areas of the world.
If you would like additional information about HIV, or any other topic on this website, please reach out to your midwife or any member of our staff so we can arrange to speak with you!
References
ACOG (September, 2018). ACOG committee opinion number 751: Labor and delivery management of women with human immunodeficiency virus. Obstetrics & gynecology, 132 (3). https://www.acog.org/-/media/project/acog/acogorg/clinical/files/committee-opinion/articles/2018/09/labor-and-delivery-management-of-women-with-hiv-infection.pdf.
American Academy of Pediatrics (February, 2013). Infant feeding and transmission of human immunodeficiency virus in the United States. PEDIATRICS, 131 (2). https://pediatrics.aappublications.org/content/pediatrics/131/2/391.full.pdf.
Gilroy, S.A.(August 20, 2020). HIV infection and AIDS Workup. Medscape.com. https://emedicine.medscape.com/article/211316-workup.
King, T.L. Brucker, M.C., Osborne, K. & Jevitt, C.M. (2019), Varney’s Midwifery (sixth edition). Jones & Bartlett Learning, LLC.
NIH (January 17, 2020) Recommendations for the use of antiretroviral drugs in pregnant women with HIV infection and interventions to reduce perinatal HIV transmission in the United States. clinicalinfo.hiv.gov. https://clinicalinfo.hiv.gov/guidelines/perinatal/overview?view=full.
Tharpe, N.L., Farley, C.L., & Jordan, R.G. (2013). Clinical practice guidelines for midwifery and women health (fourth edition). Jones & Bartlett Learning, LLC.