Patience is 29 years old and has been HIV positive for 9 years. She has remained asymptomatic and is not taking antiretroviral medication

Question

Recently she was at the drop-in clinic to talk to a public health nurse about having a baby through artificial insemination. She said she had met a man who wanted to marry her and have children with her, but she was concerned about the baby contracting HIV. Her latest blood tests indicated her CD4+ count was 380/ µL. The PCR test indicated her viral load was 850. The nurse referred her to the physician to discuss antiretroviral therapy during her pregnancy.

What are the factors that increase the chance of HIV transmission from mother to infant, and how the transmission occurs?

Patience was told that after she became pregnant, she would begin HAART therapy. Describe what this therapy is and what particular antiretroviral medication would be particularly useful to her during her pregnancy. What concern is there about administering certain antiretrovirals early in the pregnancy?

Individuals with HIV are prone to contracting opportunistic infections. What are opportunistic infections and the risk factors that leave an individual with HIV particularly prone to contracting this type of illness?

Answer 1

A number of factors increase the risk of HIV transmission from mother to infant. A mother who exhibits a low CD4+ count or high viral load during pregnancy increases the risk of transmitting the disease to the unborn child. Delayed delivery after rupture of the amniotic sac is another factor that puts the fetus at risk. Transmission can occur in utero, during delivery, or with breast-feeding.

HAART therapy refers to highly active antiretroviral therapy. The treatment protocol involves the administration of two or three antiretroviral medications that collectively destroy the HIV at various stages of replication. The aim of the therapy is to reduce the presence of HIV RNA to an undetectable level while increasing CD4+ cell counts. Zidovudine is a particularly effective antiretroviral medication to be administered to the pregnant woman as it greatly reduces the risk of perinatal transmission to the fetus. Some antiretrovirals, however, are teratogenic and should not be administered to the mother during the first trimester.

An opportunistic infection occurs when otherwise benign or common microorganisms cause disease in a compromised host. Individuals with HIV are prone to opportunistic infection because of CD4+ deficiency. The level of CD4+ cells directly correlates with the risk of developing an opportunistic infection. Viral load is another risk factor, and higher HIV RNA levels predispose the individual to opportunistic illness.