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HIV positive mothers can transmit HIV to their child anytime during pregnancy, birth or even after birth through breastfeeding. But with proper testing, antiretroviral therapy (ART) and certain measures, the chances of mother-to-child transmission of the virus can be reduced.
It is advisable to get tested for HIV before conception so that if found positive, ART can be started. In patients who are already HIV positive, viral load should be measured.
If the female is already a known case of HIV, then ART should be continued. If a woman is tested HIV positive first during the pregnancy, then immediately ART should be started which would be continued for lifetime. Taking regular ART decreases risk of mother to child transmission to less than 1 percent. Pregnant women should have regular antenatal visits where all investigations including viral load should be done as per guidelines.
Although in India, vaginal delivery is recommended unless for obstetric indication, the risk of transmission is reduced if delivery is by caesarean section. Also, if the patient is already taking ART which reduces the viral load, thus decreasing the risk of transfer of virus from mother to child.
Women whose HIV status comes out to be positive during labour ART is started immediately which would be continued for life. Viral load should also be measured if possible.
All babies born to HIV infected mothers are tested for HIV at birth, after 6 weeks and either after 18 months or after breastfeeding is stopped.
A baby born to an HIV infected mother is given ART prophylaxis for a minimum of 6 weeks for up to 12 weeks depending upon when ART was started in mother and if the baby is exclusively breastfed or exclusively replacement fed.
Indian guidelines recommend exclusive breastfeeding for 6 months and then adding complimentary food thereafter and continue breastfeeding. Breastfeeding should be stopped once an adequate nutritional diet can be given to a baby without breastmilk. If a mother cannot exclusively breastfeed the baby because of any reason, then mixed feed can be given provided that the mother is taking ART regularly. It is vital for the mother to continue her ART as it would reduce the viral load and so the risk of transmission of virus would also reduce.
Exclusive replacement feeding should be started if only there is access to safe water and sanitation, if mother or family can reliably afford to provide sufficient and sustained replacement feeding (milk) to support normal growth and development of the infant for six months, if feed can be prepared frequently enough in a clean manner so that it is safe and carries a low risk of diarrhoea and malnutrition and if the family is supportive of this practice.
Although there are chances of transmitting HIV virus through breast milk, infant feeding plans should be fixed according to the availability of resources as malnourishment is a big challenge in India. Mother should understand the pros and cons of both breastfeeding and replacement feeding and should take the decision accordingly.
The risk of transmission of HIV from mother to child can be reduced by adequate and timely ART, safe methods of delivery, good care of the mother during the antenatal period and in the postnatal period.
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