HIV can cause T-lymphocyte damage, resulting in persistent HIV causes T-lymphocyte damage, leading to persistent immune deficiency, opportunistic infections in multiple organs and rare malignancies, and eventually death. The incidence of HIV combined pregnancy is 0.3%-2% in women, and the rate of mother-to-child transmission of HIV/AIDS is 33%-35% in high endemic areas without treatment.
Diagnostic criteria
1.Stage diagnosis
(1) Clinical stage I (asymptomatic stage).
? Epidemiology: history of unsafe sex; history of intravenous drug use; history of importation of blood and blood products not tested for HIV antibodies; children born to HIV-positive persons; others (such as occupational exposure or infection of medical origin).
Clinical manifestations: often asymptomatic, in latent phase, but can have generalized lymph node enlargement.
(2) Clinical stage II (mild disease stage).
Epidemiology: same as clinical stage I.
Clinical manifestations: weight loss <10%; recurrent upper respiratory tract infections; herpes zoster; stomatitis; recurrent oral ulcers; seborrheic dermatitis; pruritic papular dermatitis; fungal nail infection.
(3) Clinical stage III (moderate disease stage).
Epidemiology: same as clinical stage I.
Clinical manifestations: ① unexplained persistent irregular low-grade fever; ② recent (within 3 months) weight loss of more than 10% and persistent diarrhea (up to 3-5 times a day) for more than one month; ③ Candida albicans infection in the oral cavity or viscera; ④ severe bacterial infections such as pneumonia and sepsis; ⑤ acute necrotizing ulcerative stomatitis, gingivitis, periodontitis; ⑥ unexplained anemia (
Epidemiology: same as clinical stage I.
Clinical manifestations: ① HIV wasting disease; ② Pneumocystis carinii pneumonia; ③ cytomegalovirus infection; ④ toxoplasma encephalopathy; ⑤ Kaposi’s sarcoma of the skin mucosa or viscera; ⑥ novel cryptococcal meningitis or cryptococcal pneumonia; ⑦ Penicillium infection; ⑧ recurrent sepsis; ⑨ recurrent bacterial pneumonia; ⑩ lymphoma; ? Active tuberculosis or non-tuberculous mycobacteriosis;? Recurrent herpesvirus infections;? Dementia in young and middle-aged patients, etc.
2. Ancillary tests.
HIV antibody test: from negative to positive. In the early stage of infection, serum HIV antibody negative, mostly in about 2-6 weeks of being infected antibody turn positive, very few extended to 3-6 months before the appearance of antibodies.
Positive HIV RNA in plasma.
CD4 cell count: CD4 cell count <350/μl as HIV infection immunocompromised.
3.Differential diagnosis
Immunodeficiency due to HIV infection can cause multiple organ lesions with diverse lesions, but it is mainly differentiated from infectious mononucleosis, hematologic diseases, central nervous system diseases, primary immunodeficiency diseases and immune insufficiency caused by drug causes, malignant tumors or severe malnutrition.
[Treatment plan
1.General treatment
Patients with HIV infection and AIDS should be given positive psychological treatment, told to pay attention to rest, strengthen nutrition and work and rest, and avoid infecting others.
2.Prevention and treatment of opportunistic infections.
3.Application of anti-HIV drugs
(1) For HIV-infected pregnant women in clinical stage I or II of AIDS, with relatively good immune function and CD4+ T lymphocyte count >350/mm3, it is recommended to adopt preventive antiviral drug regimen; for HIV-infected pregnant women in clinical stage III or IV of AIDS, with CD4+ T lymphocyte count ≤350/mm3, it is recommended to adopt therapeutic antiviral drug regimen.
Before and during the application of antiretroviral drugs, medical staff should provide continuous counseling guidance and related monitoring for infected pregnant women and the children born to them to improve medication compliance; regularly perform routine blood, urine, liver and kidney functions, CD4+ T lymphocyte counts, and viral load tests when necessary, pay close attention to possible side effects of the drugs, and provide necessary treatment or referral services.
(2) Maternal prophylactic application of antiviral drugs
During pregnancy and delivery
Zidovudine (AZT) 300 mg + lamivudine (3TC) 150 mg + lopinavir/ritonavir (Klonopin) (LPV/r) 400/100 mg twice daily or AZT 300 mg + 3TC 150 mg twice daily and efavirenz (EFV) 600 mg once daily from the 14th week of gestation (or immediately thereafter when infection is detected) until delivery. once a day until the end of labor.
After delivery
If artificial feeding is chosen, the mother can stop the antiviral medication at the end of delivery; if breastfeeding is chosen, the mother continues the antiviral medication until one week after the cessation of breastfeeding.
(3) Therapeutic use of antiviral drugs for pregnant women
Early initiation of AZT 300 mg + 3TC (lamivudine) 150 mg + NVP (nevirapine) 200 mg twice daily or AZT 300 mg + 3TC (lamivudine) 150 mg twice daily and EFV (efavirenz): 600 mg/dose once daily.
Pregnant women with HIV infection at term who are not previously treated should be given zidovudine intravenously at delivery.
Regardless of the antenatal antiretroviral regimen, zidovudine is recommended for use at delivery and for the newborn, with zidovudine applied as soon as possible after delivery, preferably 6-12 hours after birth and continuing until 4-6 weeks after birth.
4. Mode of delivery
(1) Medical personnel should provide safe midwifery services for HIV-infected pregnant women, and avoid as much as possible injurious operations such as lateral episiotomy, manual rupture of membranes, use of fetal head suction or forceps to assist delivery, and intrauterine fetal scalp monitoring, which may increase the risk of mother-to-child transmission of HIV, to reduce the chance of mother-to-child transmission of HIV during delivery.
(2) Avoid emergency cesarean delivery and choose elective cesarean delivery if necessary, and do not advocate cesarean delivery for those who are taking antiviral drugs regularly.
(3) For those with persistent HIV viral load levels below detectable levels, there is no information to suggest that elective cesarean delivery will further reduce the risk of transmission. Compared with vaginal delivery, cesarean delivery has an increased risk of maternal complications such as postoperative infection, anesthesia and other surgical risks. Postoperative care should be taken to prevent infections and complications.
(4) For elective cesarean delivery, the general timing is chosen at 38 weeks of gestation to reduce the possibility of spontaneous rupture of membranes or prodromal initiation.
5. Provide scientific infant feeding counseling and guidance.
Advocate artificial feeding for children born to HIV-infected mothers and eliminate mixed feeding. Medical staff should assess with HIV-infected mothers and their families on conditions such as acceptability, knowledge and skills, burdened costs, continued access to adequate, nutritious and safe milk substitutes, and timely access to comprehensive guidance and support from medical staff for artificial feeding. For those with artificial feeding conditions try to provide artificial feeding and give guidance and support; for those infected mothers and their families who choose to breastfeed because they do not have artificial feeding conditions, do a good job of adequate counseling and guidance, tell them to insist on exclusive breastfeeding, feeding time is best not to exceed 6 months, and actively create conditions to change to artificial feeding as soon as possible.
6. Provide follow-up and HIV testing for children born to HIV-infected mothers.
Children born to HIV-infected mothers should be followed up at 1, 3, 6, 9, 12 and 18 months of age to provide routine health care, growth and development monitoring, infection status monitoring, guidance on malnutrition prevention, immunization and other services, and to keep detailed records of information related to child follow-up.
Early diagnosis of HIV can be started as early as 6 weeks after birth for children born with HIV infection, and HIV antibody screening tests are routinely performed at 12 months of age.
[Efficacy assessment
At the end of delivery, opportunistic infections are controlled and CD4 cell counts return to normal.