The coming out of the late Sarah Jane Salazar in the 90’s was the the first time the Philippines became aware about AIDS. She had been a public figure and her moves became news to her countrymen. She made us cautious about the things we touched and in dealing with our friends and neighbors because we thought that it could be contracted by usage of public toilets or sharing dining plates and silver wares.Fortunately,further research and information campaign made it clear to us that it could only be obtained by getting intimate with the infected individuals, getting exposed to the infected body fluids and by blood transfusion. However, Sarah got us even more terrified when she announced that she got pregnant. We were afraid that her unborn would get her disease. We knew a little about the course of disease perinatally, back then.Fortunately, the medication she took made Lyka safe from the HIV.
According to the article written by Marino in medscape.com, the usage of antiretrovirals has helped in the reduction of perinatal transmissions of HIV from 25.5 % to 8 %. The exact mechanism of transmission is still unknown.The American Congress of Ostetrics and Gynecology (ACOG) website says that it can happen anytime during pregnancy through the fetomaternal circulation , by passage through the birth canal and by breastfeeding.The risk is highest among those with high viral load.
Marino wrote that the ACOG recommends routine screening of the HIV for those who are 19 to 64 years old.However, several state laws urged the signing of consent forms prior to the testing.In the Philippines, the screening is not yet mandatory because consent also has to be granted before physicians request for the HIV test.Complete blood count ,lipid profile, renal and liver function profiles, CD4 count and HIV RNA copy number, which determines viral load, are obtained to evaluate the condition of the patient. High viral load and low CD4 levels, according to the ACOG website, indicate risk of transmitting the virus to the fetus. Marino added further that antiretroviral resistance studies must be done before initiating any antiHIV medications.However, those who presents late in the pregnancy should start taking the drugs while they wait for the results to come out. The antiretrovirals could make the viral load undetectable in 6 months time. Otherwise, the failure in treatment is likely.According to Gonzales et al., the Pediatric Aids Clinical Trial Group, zidovudine can be given during pregnancy from the 14 weeks age of gestation, and via intravenous route during labor. The neonate should receive it for 6 weeks.ACOG , however recommends continuation of treatment for the pregnant women who had the medication prior to their pregnancy. Lamivudine and Nevirapine can be added as combination, according to Marino.
Furthermore, the ACOG, Sumpaico et al. and Marino supports the idea of testing the HIV patients for the presence of other forms of sexually transmitted diseases. The hepatitis B and C should also be detected.
Sumpaico et al. recommends the cesarean delivery (CS) for the patients with this condition because the rupture of the water bag during labor could expose baby to the virus.According to the ACOG website, the CS is scheduled at 37 weeks age of gestation to avoid the labor process. Marino said that the low CD4 of the patients can be risky for the procedure, but antibiotics could help alleviate the risk. The benefit should be weighed against the risk of exposure of the offspring to the dreaded virus.
List of Sources:
Atencio, J. AIDS Victim Sarah Jane Passes Away.Manila Bulletin.June 12,2000.
Marino T. HIV in Pregnancy. http://emedicine.medscape.com/article/1385488-diagnosis
Gonzales, L, Manalastas R, Gomez DC, Villanueva G, Cu-Uvin S. Seroprevalence of HIV in Pregnant Women in the Philippine General Hospital. http://www.psmid.org.ph/vol29/vol29num4topic3.pdf
Sumpaico WW, Ocampo-Andres IS, Capito LRB, Diamante AN, Carnero S, Gamilla Z. Textbook of Obstetrics, 3rd ed. 2002 . Association of Writers of Philippine Textbook of OBGYN,Inc. Quezon City.