Aids and Pregnancy

AIDS and Pregnancy

1. Definition/Description: The name of the disorder is AIDS and pregnancy. The virus that is known as AIDS can be transmitted from an infected mother to her newborn child. 20-30% of babies that come from infected mothers get HIV (4).

2. Pathophysiology: Human immunodeficiency virus (HIV) is the causative agent for AIDS. The most common type is known as HIV-1 and is the infectious agent that has led to the worldwide AIDS epidemic. HIV is a sexually transmitted disease (5). The CD4+ T-lymphocytes have surface receptors to which HIV can attach to promote entry into the cell. Mothers who are HIV infected can pass the virus on to their fetuses in utero or to infants via breast milk. The longer the delivery process the more likely the baby will be infected. "When the CD4 lymphocyte count drops below 200/microliter, then the stage of clinical AIDS has been reached" (1).

3. Presenting complaints/common history findings: Both sexually transmitted diseases and pregnancy are markers for unsafe sexual activity and, in addition, sexually transmitted diseases increase susceptibility for HIV infection, so a detailed sexual history must be obtained. Assess number of partners, age differential, and partner's known risks. Assess consistency of contraceptive use. Assess for history of sexual abuse or rape.

4. Positive physical exam findings: in the physical exam section a chiropractor would obtain a medical history including current mediations and any allergies. The most common way that women become infected is through unprotected sex (5). Most babies born from infected mothers test positive for HIV antibodies in their blood, but it does not necessarily mean that the baby is infected. If the child is not infected then the anti-bodies should disappear within 12 months (3). If the baby is infected then their immune system will make antibodies and they will continue to test positive and develop serious symptoms and or die. A HIV viral load test can be done on the baby also. This test detects HIV virus in the blood. Pregnancy does not seem to make the mothers HIV disease any worse (2).

5. Positive Lab Tests: A pregnant women has the option to be tested for HIV. She can specifically request one or she can have one to be included in the standard group of tests that a pregnant woman receives. The Western blot test determines the body's immune response to a specific HIV particle (1). HIV can detect antibodies in serum, plasma, oral fluid, dried blood spot or urine of patients. The CD4 T-cell count is not an HIV test but it is used to monitor the immune system function in HIV+ people. "When the CD4 lymphocyte count drops below 200/microliter, then the stage of clinical AIDS has been reached" (5).

6. Special Diagnostic Studies: An ELISA test sometimes is the first and most basic test to determine if an individual is positive for HIV. This test is very sensitive and detects almost all persons infected with the human immunodeficiency virus (HIV) except during the first few weeks of infection.

7. Positive Radiograph Findings: Opportunistic infections are common to AIDS patients. The most common to both babies and adults Pneumocystis carinii pneumonia an Upper respiratory tract infection. Chest radiograph findings may be subtle with small areas of non-specific air space, shadowing or increased haziness in the periphery of the lungs. X-rays can reveal areas of opacity which represent consolidation.

8. Red Flags: HIV and AIDS can be associated with many physical and emotional problems. Opportunistic infections are a serious problem for people that have AIDS. Babies are at even more risk of developing theses infections from common bacteria and due to their weakened immune systems. Chiropractors need to be aware of the possible infections and refer to their MD for antibiotic treatment. Look for flu-like symptoms diarrhea, thrush, depression, rapid weight loss, fatigue, nausea vomiting

9. Allopathic Approach: Pregnant women