The work of a health care practitioner requires knowledge and practice in different areas of clinical work. Practitioners should have expertise in tissue and organ structure as well as the patterns of the functioning of different infections and viruses. The awareness of the principles of diverse body systems functioning and their reaction to different infections and pathologic conditions is vital for successfully diagnosis and treatment of patients. The analysis of the case study that is related to the acquired immunodeficiency syndrome enhances the understanding of the principles of transmission of HIV infection from mother to infant. The most critical aspects to consider in the discussed case scenario include the factors that increase the chance of transmission of HIV, the specifics of HAART therapy, and the risk of development of opportunistic infections. The performed analysis increases the awareness of nurses and physicians of the ways of prevention of the risk of HIV transmission from HIV-positive mothers to their infants.
According to the proposed case scenario, a female patient at the age of 29 named Rachel (not real name) has been HIV-positive for 9 years and has an intention to have a baby. The consideration of the patient regarding the risk of the transmission of the virus to her future infant raised the need for the analysis of the three perspectives related to the problem. These issues include the chances of HIV transmission and the process of transmission itself, the peculiarities of HAART therapy, and the risks of developing opportunistic infections.
HIV Transmission from Mother to Child
The chance of HIV transmission from mother to infant is dependent on different issues that range from the progress of infection to the vulnerability of the organism of the child. The first critical factor to consider is the state of the viral load, which directly correlates with the probability of the virus to be transmitted. For example, Ngwende et al. (2013) argue that “HIV infection among children increased if the mother’s CD4 count was ≤200 cells/μL.” Therefore, a low ratio of CD4 and a high viral load in the maternal organism increases the probability of HIV transmission to the child. Similarly, the scholars state that breastfeeding exclusively for less than 6 months is safe for the child whereas mixed feeding is a risk factor for the transference of the virus (Ngwende et al., 2013). Experts indicate that mother-to-child HIV transmission risk is the most considerable after blood transfusion and constitutes 2260 per 10 000 exposures to an infected source (Patel et al., 2014). However, it is possible to reduce such risk by clinical methods even in case a mother has HIV infection. In this sense, the clinicians have to be aware of the principles of transference.
The most common pathways of the transmission of HIV from mother to child include the ones that involve the transference of blood and other liquids and substances. Accordingly, among the most common ones are breastfeeding after the birth as well as intrapartum, and in utero (“World Health Organization,” 2017). During a prenatal period, HIV transference is possible through the transfusion of blood whereas during a postnatal period, the transference occurs through mother’s milk. At the same time, the modern scholars still lack a comprehensive understanding of the principles of mother-to-child HIV transmission. The only information that has been approved is that one of the most effective measures to do this is an antiretroviral treatment (Patel et al., 2014). The education relating to the correct ways of breastfeeding should follow the treatment initiative in order to lessen the danger of postpartum HIV transmission (“World Health Organization,” 2017). Therefore, the patient requires antiretroviral therapy before she becomes pregnant.
Currently, antiretroviral therapy is one of the most trusted ways for prevention of mother-to-child HIV transmission. For this reason, all pregnant women were suggested by WHO to follow this defensive initiative, notwithstanding “clinical stage of disease or CD4 count” (“World Health Organization,” 2017). HAART therapy is grounded on the experience of shifting from different antiretroviral options in Malawi, who represent one of the African communities that suffer from HIV/AIDS. Before 2015, PMTCT program has been validated presuming that mothers and infants had to administer nevirapine and zidovudine single and twice daily respectively (van Lettow et al., 2014). However, the modern therapy approved by WHO as a more efficient substitute for the previous one advises using a single fixed dose of tenofovir, lamivudine, and efavirenz (van Lettow et al., 2014). Thus, the administration of these medications is directed toward suppressing the activity of the virus and reducing its capability of transference.
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The modern HAART is entitled Option B and has been approved as an efficient means of the prevention of mother-to-child HIV transmission. According to it, the combination of nevirapine, zidovudine, and lamivudine is required at the fourth week of pregnancy followed by “an intravenous NVP administration intrapartum and postpartum NVP syrup to the respective infants for six weeks” (Ngemu et al., 2014). The administration of the above-mentioned medications early in the pregnancy is critical for controlling CD4 cell counts and reducing viral load. In this sense, it has been experimentally approved that mothers, who were the subjects of HAART therapy, had significantly higher mean absolute of CD4 cells and reduced viral load after the therapy (Ngemu et al., 2014). Therefore, for Rachel, HAART is vital in order to reduce the risk of HIV transference to her child to the minimum. At the same time, she has to take into account the risk of contracting opportunistic infections that can endanger both mother and her future child.
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Opportunistic infections pose a specific risk to HIV-infected patients, as they can damage different organs and body systems, which is especially dangerous for infants and children. Opportunistic infections are infections that take advantage of the immune system of a person weakened by the activity of HIV and chemotherapy and occur more frequently and are more severe (“U.S. Department of Health and Human Services,” 2017). The most common infections that represent the category of opportunistic ones include tuberculosis, toxoplasmosis, pneumonia, Salmonella infection, and candidiasis (“U.S. Department of Health and Human Services,” 2017). The high risk for these infections to endanger the body of a HIV-infected patient is connected with the activity of the immunodeficiency virus. The reason for this is that the virus multiplies using immune cells of the host, weakening its immune response, whereas the infections themselves are caused by various germs that spread in the air as well as through saliva, blood, semen, urine or feces (“U.S. Department of Health and Human Services,” 2017). Thus, the high probability for a HIV-infected individual to develop an opportunistic infection is caused by the constant decrease of his or her immune system so that constant exposure to infected tissues or agents provokes the development of a disease. Opportunistic infections are especially dangerous for HIV-infected people, as they are the main causes of their death (“U.S. Department of Health and Human Services,” 2017). For this reason, the above-mentioned category of people requires constant medical protection from the mentioned opportunistic infections.
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HIV poses a serious risk to the future child in the case his or her mother has a HIV infection due to the high activity of the virus and diverse pathways of its transference. In order to reduce the risk of mother-to-child HIV transmission, HAART therapy has been approved by WHO as the most effective preventive measure. The core of this antiretroviral therapy is the administration of nevirapine, lamivudine, and zidovudine at the early stage of gestation. Infants require administration of nevirapine syrup throughout 6 weeks after their birth. HIV-infected individuals require constant protection from opportunistic infections such as tuberculosis, pneumonia, candidiasis and others, as these infections are vitally dangerous for them due to the weak immune response of an organism damaged by HIV.