Work experience and development of interaction between specialists of medical organizations in conducting dynamic monitoring of pregnant women in contact with HIV-infected sexual partners in the Saratov region

Abstract

BACKGROUND: In HIV-discordant couples, questions often arise about the possibility of having a child. Under current conditions, with the availability of antiretroviral therapy, such couples can have healthy children, subject to specific requirements. No approved algorithm exists for examining and monitoring of pregnant women in contact with HIV infection. AIM: This study uses a team approach that comprises specialists from medical organizations to monitor discordant couples in which the man is HIV positive, and the woman is HIV negative at any stage of pregnancy. MATERIALS AND METHODS: A retrospective study was conducted from 2018 to 2021 from medical records of 158 discordant couples in which the man is HIV positive and the woman is HIV negative. The detection results of HIV infection were evaluated by detecting HIV antibodies, HIV DNA/RNA in healthy pregnant women and CD4 lymphocytes, and HIV RNA in HIV-infected sexual partners. Safety measures were observed for medical personnel and the patient during medical interventions. RESULTS: Discordant couples under observation were divided into 2 groups and totaled 158 couples. They included 69 (43.3%) couples who were observed at the Center for AIDS and were planning a pregnancy and 89 couples (52.9%) who first applied to the medical organization about a pregnancy that had already occurred. In the first group, sexual partners were on antiretroviral treatment until the wife became pregnant, and the viral load was undetectable. In 100% of cases, there was no HIV transmission to a woman in this group during pregnancy. In the second group, 52 (58.4%) HIV-infected sexual partners and 37 (42.5%) couples not receiving antiretroviral therapy received antiretroviral therapy. In the second group of discordant couples, HIV transmission was 1.1% (1 woman). CONCLUSIONS: It is necessary to develop, approve, and implement an algorithm that includes monitoring discordant couples from the moment they are registered, examining the sexual partners of pregnant women in 100% of cases, and developing a team approach to monitor pregnant women.