Preventing Mother-To-Child Transmission of HIV

According to UNAIDS 2012 report, 34.2 million people are living with HIV worldwide. Among them, women represent half of the population. As per the report, 3.4 million children globally are living with HIV infection where 2,50,000 children who are less than 15years die from AIDS-related causes.

Back home, according to Nagaland State AIDS Control Society (NSACS 2013) there were 14,563 people living with HIV, out of which 16% were between the age group of 15 to 24 years, making Nagaland as the top 6 states with HIV in the country. It is estimated that out of 27 million pregnancies every year in India, nearly 49,000 occur with HIV-positive women. So now, are all the child born to HIV positive mothers infected with the virus? MTCT (Mother-To-Child-Transmission) remains the commonest mode of transmission in children. However, not every child born to HIV infected mother is HIV positive. That is, MTCT is not 100%.
What is MTCT (Mother-To-Child-Transmission)?

MTCT is when an HIV-positive mother passes the virus to her child during pregnancy, labour, delivery or breastfeeding (WHO 2011).
How common is MTCT today?

In developed countries MTCT has been almost completely eliminated as a result of effective voluntary testing and counseling services, access to safe delivery practices, and the widespread availability and safe use of breast-milk substitutes. In the absence of Antiretroviral Therapy (ART) and other intervention in India, MCTC is about 25-30%.  However, with intervention and medication it can be as low as 1-2%. Globally in 2012, 62% of pregnant women living with HIV received the most effective drug regimens - Antiretroviral Therapy (ART) (as recommended by WHO) to prevent Mother-To-Child Transmission (MTCT) of the virus.
How to Preventing Mother-To-Child Transmission (PMTCT)?

In July 2013, the World Health Organization (WHO) issued new HIV and AIDS guidelines on treatment for PMTCT and on HIV and breastfeeding
1.    An HIV-positive mother can pass the virus to her baby any time during pregnancy, labor, delivery and breastfeeding. Therefore HIV-positive pregnant mothers should take Antiretroviral Therapy (ART) as soon as possible throughout pregnancy, delivery and breastfeeding and continue for life.
2.    As soon as the infant is born, the baby should also be given ARV drugs. It is highly recommended that the child should be given only artificial feeding rather than breastfeeding. Exceptions only on cases like increased risk of death from diarrhea and malnutrition.
Barriers and challenges in PMTCT
1.    In many low and middle-income countries, health systems are often poorly staffed and resourced; clinics struggle to provide existing services.
2. Even where quality PMTCT services are locally available, there may be social, cultural stigma or personal reasons why women do not access PMTCT services
3. Fear of disclosure and being known by others is a common reason why women are reluctant to go to HIV clinic/ health care services.
4. Poor adherence to ARTs.
How to Care for HIV Exposed children?
Women with HIV who take ART and related medication during pregnancy as recommended, can reduce the risk of transmitting HIV to their babies. Therefore, the immediate period after birth is very crucial to prevent transmission in exposed children. Antiretroviral (ARV) prophylaxis should be administered to the child, depending on what mother has already received.
What are feeding options of the infant?
The HIV infected mother should be already informed - counseled before the delivery, regarding the feeding options of the baby. Studies have shown that, if a mother infected with HIV, without any treatment and intervention breastfeeds her baby, the chances of transmission is almost 20-35%. Hence, mothers are strongly advised by health care providers to go for replacement feeding. But we should also remember that sometimes replacement of feeding may complicate certain situation which may overweight the risk of HIV infection. So in order to avoid complications, it should be ensured that replacement feeding is Acceptable, Feasible, Affordable, Sustainable and Safe (AFASS).
In case the mother opts for exclusive replacement feeding, then it is important to remember that they should use clean preparation of the feed and preference of the use of spoon and cup instead of nippled bottle in order to prevent contamination. However, if the mother opts for exclusive breastfeeding, then she should remember to give exclusive breastfeeding for six months without mix feeding even water, as mixed feeding are most risky in the context of HIV transmission. Mother should take immediate treatment for cracked sore nipples during breastfeeding period. Furthermore, the mother should also ensure that abrupt replacement of feeding should be done on weaning.
What about Immunization of the Infant?
Immunization like BCG and oral polio live vaccine (OPV) should be avoided if the baby is already symptomatic of HIV infection.
Hence, we learn that consequences such as Mother-To-Child-Transmission (MTCT) of HIV can be prevented by taking sensible medical guidelines and prognosis. Above all, one should not shy away, wish or curse the disease but rather have a big heart to accept the sickness and a steeled determination to live and let live.