What is AIDS and what is its effect during pregnancy?

Acquired immunodeficiency syndrome, or AIDS, is caused by a virus that attacks your immune system. The AIDS virus is called the human immunodeficiency virus, or HIV. When your immune system can't fight disease, you may become sick with many infections that the body would normally fight off. Such infections are called opportunistic infections.

If you are pregnant and you are infected with HIV, your baby may be infected by the virus before or during birth. The baby can also get the virus from the breast milk of an infected mother. If the baby does get the virus, he or she may become very sick and die.

Between 20% and 40% of the babies born to HIV-infected mothers become infected with the virus. Half or more of these infections occur during labor and delivery.

You should ask to be tested for HIV at your first prenatal visit.

How does HIV infection occur?

HIV infection is passed through unprotected sexual activity with an infected partner, transfusion with infected blood, shared needles, or contact with infected body fluids (for example, blood or breast milk). HIV can be passed to an unborn baby through the placenta, by exposure to blood and body fluids during labor and at delivery, or through breast- feeding.

What are the symptoms?

You can be infected with HIV and not have any symptoms. Or you may have one or more of the following signs and symptoms:

• unexplained weight loss
• tiredness and just not feeling well
• fever that lasts from a few days to longer than a month, with no other disease present and no other obvious cause
• diarrhea, especially if it lasts longer than a month and no other disease is present
• unexplained, prolonged swelling of the lymph nodes
• a certain kind of sores or changes in the skin that last more than 4 weeks, including persistent or recurring herpes infections
• oral, esophageal, lung, or vaginal yeast infections
• abnormal Pap tests.

Infants infected with HIV may not have symptoms until they are 9 months old. However, half of all children infected by their mothers will develop symptoms before they are 1 year old. Most infected children have symptoms before they are 3 years old. Some of the symptoms infants may have are:

• poor growth and weight gain
• enlarged spleen and liver
• chronic pneumonia (lung infections)
• enlarged lymph nodes
• chronic or recurrent diarrhea
• low blood counts
• birth weight less than 5 pounds
• recurrent ear infections
• rash
• failure to develop normally
• small brain.

How is HIV infection diagnosed?

The screening test for HIV is a blood test called the ELISA test. When this test is positive, another more specific blood test, usually the Western blot test, is done to confirm the diagnosis. If both tests are positive, you are infected with HIV. Tests can usually detect HIV infection within several weeks of your exposure to the virus. Sometimes, however, you may not test positive for several months.

A baby is given the ELISA and Western blot tests after birth. However, because some of the mother's antibodies to HIV are passed on to the baby, the test results are not always completely accurate. If a newborn's tests are negative, you cannot be sure that the child is not infected with HIV until many months later.

HIV tests are always strictly confidential whether the results are positive or negative.

How is it treated?

If you test positively for HIV, you may have more tests, such as:

• tests for other sexually transmitted diseases, including hepatitis B and syphilis
• test for tuberculosis
• blood tests for previous cytomegalovirus (CMV) and toxoplasmosis infections
• ultrasound scans to check for normal growth of the baby in your womb
• nonstress tests during the latter part of the pregnancy to check the baby's heartbeat for signs of stress
• tests of your immune system.

If you are pregnant and have tested positively for the HIV virus, your doctor will probably prescribe the drug zidovudine (also called ZDV or AZT). Other drugs may be prescribed as well. Taking these drugs during pregnancy and labor significantly reduces the risk that you will give the infection to your baby.

You may be treated with medication for an opportunistic infection such as pneumonia or herpes.

During labor and delivery you do not need to be isolated. All hospital personnel now use special precautions when they handle blood or other body fluids to prevent the spread of AIDS. Make sure that you tell all your health care providers that you are HIV positive.

You should not breast-feed your baby. Give formula to your baby instead to prevent passage of the virus to the baby.

What can be done to help prevent HIV infection during pregnancy?

Ask for counseling and testing if you are pregnant or plan to become pregnant and are in any of the following high-risk groups:

• women with signs of HIV infection
• intravenous (IV) drug abusers and other drug abusers, such as cocaine addicts
• sexual partners of men who are infected with HIV
• prostitutes
• women with more than one sexual partner or whose sexual partner is sexually active outside the relationship (especially women who live in areas where there is a high occurrence of HIV infection)
• sexual partners of men who are drug abusers, bisexual (they have sex with men and women), hemophiliacs, or were born in countries where transmission of HIV to heterosexuals is high
• women who received transfusions of blood between 1978 and 1985 that were not screened for HIV
• women from countries where there is a high occurrence of AIDS in heterosexuals, such as Haiti, the Dominican Republic, central Africa, and Brazil
• women who received semen from a sperm bank for artificial insemination.

Know your partner. Ask about your partner's sexual history and if he or she has ever used IV drugs. Do not share toothbrushes, razors, and other implements that may be contaminated with body fluids.

If you have a high risk of being infected with HIV, you should be tested for HIV before you try to get pregnant.

If you know that you are infected with HIV, you should seriously consider the grief and high cost of having a baby infected with HIV. Try to avoid becoming pregnant. Follow safe sex practices (including the use of latex condoms) to prevent transmission of the infection to others.

If you are already pregnant and infected with HIV and your baby does not become infected with HIV during your pregnancy or delivery, your child may stay free of the infection if you do not breast-feed.