Describe the factors that induce transmission of the HIV virus from mother to her baby and how does breastfeeding effects it compared to bottle-feeding? What are the four major stages of HIV/AIDS disease? During which stage(s) can HIV be transmitted? What are the main prognostic markers of HIV disease progression - which is the best indicator? Please...help. A mom can pass HIV on to her baby at three different stages: in utero, intrapartum (birth), and post-partum (breast feeding).
Antepartum:
*the placenta does a good job of keeping HIV out (though it allows for the mom's antibodies to be shared)
-invasive diagnostic procedures are usually avoided (amnio, chorionic villus sampling, or cordocentesis --anything that may compromise the integrity of the placenta.....important to note this is based on theoretical risk as the procedures have not been formally evaluated
-controlling the mothers viral load is important. The higher the maternal viral load the higher the likelihood of transmission occuring in this stage....a mother should be started on ARV therapy around week 12-14.
Intrapartum:
-it is well accepted that 2/3 of cases of Mother to Child Tranmsission (MTCT) occurs at the time of labour and delivery.
-precise mechanisms of transmission are unknown , possibilities include transfusion of blood from mother to fetus during uterine contractions, fetal infection after rupture of the membranes or exposure of the fetus to contaminated blood/secretions during the passage through the maternal genital tract.
-so, minimizing the duration of contact between maternal and fetal blood and secretions may help to decrease MTCT
-increasing evidence points to minimizing or eliminating the time spent in labour resulting in a significant decrease in MTCT
-several studies have described an association between (clinically/histologically confirmed) chorioamnionitis and HIV transmission....mosre study is needed.
-C-sections before membrane rupture does reduce the risk of MTCT (it is not known whether a C-section offers any additional benefit to a woman already in labour, women with pre-labour rupture of membranes, women who are reciving combo ARVs, or women with low or undetectable viral loads)
-the use of antiretroviral therapy is the current recommendation for most HIV positive pregnant women; its use may decrease the rate of MTCT such that the added benefit of a C-section is negligible (several studies have documented NO cases of MTCT when the maternal viral load was less than 500-1000 copies/mL....with proper ARV treatment the viral load can easily be less than 50 copies/mL.
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Postpartum:
-The baby would be started on a regimen of ARVs immediately after birth as a sort of post-exposure prophylaxis...the regimen may be one drug, or a triple cocktail depending on the OBs estimation of the exposure. This treatment can last about 6 weeks.
-HIV+ mothers should not breast feed unless they absolutely have to (eg. women living in extreme poverty in a resource-limited country whose baby would die without the food as the woman has no access to formula) as there is a risk for MTCT. In many countries the act of an HIV+ woman breastfeeding her baby is illegal.
-New research shows that for the poor women I mentioned above, with no other options, they can still practice harm reduction. Studies show that as long as the baby receives ONLY breast milk and NOTHING ELSE (no juice, no water, NOTHING) the risk of MTCT via breastfeeding is reduced significantly, but the risk is still very much present. The theory behind this is that water/juice irritates the lining of the baby's GI tract and faciliates transmission
FOUR MAJOR STAGES:
Acute/Primary Infection
Asymptomatic
Symptomatic
AIDS
HIV can be transmitted at ALL stages, however transmission is more likely in the primary stage as the levels of virus in the blood and body fluids is probably at its highest making the person more infectious.
Main prognostic indicators for HIV disease progression:
Viral Load (blood)
CD4+ cell count and percentage
Onset of symptoms
These are the most common prognostic indicators for disease progression.
The best indicator? CD4 cell count is the most reliable indicator of prognosis. And the CD4 percentage is useful when only looking at one lab test (CD4 counts can vary) and are according to one large observational study the most useful predictor of the risk for development of opportunistic infections.
Hope this helps
Other I don't have all the answers, but I do know that you CAN NOT breastfeed if you are positive....Depending on the stage you are in, there are different drugs given to protect the fetus. Some are given throughout the pregnancy, some given only before childbirth. You have to discuss all options with your doctor....I am eager to have a child, so I have been researching safe ways to accomplish having a baby without transferring my disease....it is possible.
I am not sure about all the stages-they are all bad in my opinion....I do know this- IT CAN BE TRANSMITTED IN ALL STAGES. Beyond that, most don't know they have it until another medical issue comes to light. Indicators vary from person to person,....my body may show completely different signs than yours,....the carrier who passed it to me did not show any signs of illness, but my body reacted immediately.
I hope this small bit of info helps! Sounds like a university type essay question to me!
Try researching scientific papers in journals
ISI web of knowledge is very good as is Science direct! |
