Possible Interdisciplinar Standard for the Care of Pregnant Women Living with HIV-Polish Experience
Abstract
:1. Introduction
- effective identification of reports received from healthcare entities via the patient identifier (patient’s initials + date of birth + gender + the last number of pesel (personal id. no.)),
- electronic reporting of new cases of HIV by laboratory managers, as well as physicians diagnosing HIV and certifying deaths of HIV+ persons,
- combining information from available databases, developing the scope of information in order to monitor the continuum of care of HIV patients in Poland, and the impact of migration to HIV epidemiology,
- full transparency in determining national recommendations and using them for national and international monitoring [9].
2. Methods
3. The SARS-CoV-2 Pandemic vs. HIV as a Specific Interdisciplinary Issue
- the differences between HIV and AIDS,
- the efficiency and necessity of taking antiretrovirals and the resulting side effects (early and late),
- the ways of monitoring treatment effectiveness, and
- the benefits of appropriate and systematic adherence to medications.
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- to perform a detailed physical examination encompassing the sexual life, including:
- ✓
- sexual orientation;
- ✓
- the meaning and place of sexual contact in the patient’s life;
- ✓
- the characteristics of sexual behaviors;
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- the assessment of possible dysfunctions in sexual behaviors;
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- to pass on knowledge of established and recommended principles of infection prevention;
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- to educate patients in:
- ✓
- the routes of infection transmission,
- ✓
- sexual activity and the related risk of transmission of HIV to a partner,
- ✓
- the ways of minimizing the risk of HIV infection through sexual contact,
- ✓
- the necessity of informing a partner of one’s serological status, and
- ✓
- the principles of reliable contraception.
- eating 4–6 meals daily,
- energy intake of 30–35 kcal/kg body weight,
- protein intake of 1.5 g/kg body weight (1/2 animal protein, e.g., lean meat, milk and dairy products, fish),
- 30% of daily energy requirements in the form of fats from butter, cream, milk, and oils,
- eliminating animal fat products, i.e., lard, pork fat, and fat,
- 55–60% of daily energy requirements in the form of carbohydrates,
- intake of micronutrients covering 100–150% of recommended daily allowance.
4. HIV in Pregnant Women = As the Special Obstetric Situation
- specialist for infectious diseases,
- obstetrician,
- neonatologist and pediatrist,
- midwife, and
- a dermato-venereologist.
5. Recommendations for a Period of Pregnancy [28,29,30]
- It is necessary to offer examination for HIV for all pregnant women during the first visit to a physician-obstetrician (noting conducting an examination or refusing examination in maternity notes and in medical documentation),
- A positive result (HIV+) should be communicated to the patient and attending physician no later than two weeks after conducting an examination,
- It is necessary to quickly ensure for pregnant women HIV+ consultation with a physician-specialist of infectious diseases in order to begin therapy,
- A pregnant woman who is addicted to psychoactive substances should be additionally subject to the care of a physician-psychiatrist (ensuring substitution therapy) and social worker,
- A center that takes antepartum care sends pregnant woman HIV+ to section with III reference degree in the 36th week of pregnancy,
- At pregnant women HIV+ examinations for other sexually transmitted infections should be conducted at the beginning of pregnancy and repeated in 28 weeks of pregnancy, including viral hepatitis C and B,
- It is necessary to offer for women who report to delivery without the result of examination for HIV to conduct a rapid test before admission labor ward, especially in the case of women who did not give consent to such examination earlier.
6. Monitoring and Prophylactic Antiretroviral Therapy (ARV)
- Decision of beginning antiretroviral therapy and the way of applying and monitoring it during pregnancy is taken by a physician for infectious diseases who specializes in the therapy of women who live with HIV, according to recommendations of the Polish Scientific Society of AIDS
- During pregnancy monitoring therapy ARV (control of a number of CD4 and viremia (VL every 12 weeks). The last examination was in 36. week of pregnancy.
- The World Health Organization recommends that all pregnant and breastfeeding women with HIV irrespective of CD4 cell count, viral load, and clinical stage should have triple antiretroviral drugs, which should be maintained throughout the period of the risk of MTCT (late pregnancy, labor, and breastfeeding) and continued for life as for other patients with living HIV [31].
7. Care during Delivery and in the Postpartum Period
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- Taking care of bearing woman HIV+ by medical personnel after earlier becoming acquainted with results of examinations,
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- Indications to Caesarean section, fixed by the Polish Gynaecological Society are the same as in the case of women who are not infected with HIV,
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- Caesarean section for women with HIV+ should be carried out for all women who obtain combined antiviral therapy with a detectable level of viremia (>50 copies RNA of HIV/mL),
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- •
- Planned caesarean section should be considered in pregnant women with a viral load of 50–399 copies of HIV RNA at 36 weeks of pregnancy.
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- Vaginal delivery may be considered in pregnant women with a viral load <50 copies of HIV RNA at 36 weeks of pregnancy and in the absence of obstetric complication
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- Elective Caesarean section should be considered at:
- ✓
- Coexistence of infection with HIV and HCV, and
- ✓
- Treatment with highly active antiretroviral therapy (HAART),
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- Avoiding invasive obstetric procedures (amniotomy, sampling pH from fetal scalp, episiotomy, obstetric forceps, and vacuum extractor) during delivery with forces of nature,
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- Medicating a child with antiretroviral medicaments—the exact time of beginning prophylactic therapy ARV should be noted in medical documentation,
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- Treatment of new-born babies should be adapted to recommendations of the Polish Scientific Society of AIDS and earlier arrangements of physicians who took prepartum care,
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- It is necessary to conduct examinations on new-born babies according to recommendations of the Polish Scientific Society of AIDS within the first 5 days of life,
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- Avoid breastfeeding.
8. Conduct with a New-Born Baby of a Mother Infected with HIV
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- Exact washing new-born baby as soon as possible after birth,
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- Procedure of siphoning off an upper respiratory tract of the new-born baby of amniotic fluid and other secretions of the mother,
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- Implementation of prophylaxis in the first 24 h from the moment of delivery,
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- Vaccination against viral hepatitis, in the case of children of mothers with HBsAg (+) together with immunoglobulin anti-HBs (within 12 h),
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- Absolute contraindication to vaccination with BCG,
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- Laboratory tests (the first 5 days of life of a new-born baby):
- ✓
- peripheral blood count with differential count,
- ✓
- marking the number of lymphocytes CD4 and CD8,
- ✓
- viral culture, PCR HIV.
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- Further treatment of newborn babies in a reference center.
9. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
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Plagens-Rotman, K.; Merks, P.; Pisarska-Krawczyk, M.; Kędzia, W.; Justyna, J.; Czarnecka-Operacz, M.; Jarząbek-Bielecka, G. Possible Interdisciplinar Standard for the Care of Pregnant Women Living with HIV-Polish Experience. Healthcare 2022, 10, 1949. https://doi.org/10.3390/healthcare10101949
Plagens-Rotman K, Merks P, Pisarska-Krawczyk M, Kędzia W, Justyna J, Czarnecka-Operacz M, Jarząbek-Bielecka G. Possible Interdisciplinar Standard for the Care of Pregnant Women Living with HIV-Polish Experience. Healthcare. 2022; 10(10):1949. https://doi.org/10.3390/healthcare10101949
Chicago/Turabian StylePlagens-Rotman, Katarzyna, Piotr Merks, Magdalena Pisarska-Krawczyk, Witold Kędzia, Jaskulska Justyna, Magdalena Czarnecka-Operacz, and Grażyna Jarząbek-Bielecka. 2022. "Possible Interdisciplinar Standard for the Care of Pregnant Women Living with HIV-Polish Experience" Healthcare 10, no. 10: 1949. https://doi.org/10.3390/healthcare10101949