Clinical examination of children born to HIV-positive mothers. "Orphan child (contact with HIV) - how to help find adoptive parents?" What is HIV contact in a child?

If anyone has any information, please give me some advice.
The problem is this. My once friend and roommate in the hostel, later just a good friend, died in early August of this year, 2 weeks after giving birth, from blood poisoning. Because in the last 2 years I became addicted to injecting drugs and acquired a “bouquet”: HIV and hepatitis C. Which contributed to such a sad ending. Three children remained.
The older girls were sadly taken apart by relatives; no one wanted to take the younger boy. From the r/d he was transferred to the perinatal center (he was gaining weight poorly), from there to a children's hospital with an inpatient facility for children left without parental care.
Today I called there to find out, at least in general terms, how the baby was doing and whether he needed any financial help. The child is still thin and underweight, I didn’t try to ask for other details. And so, strictly speaking, they shouldn’t have said anything. It’s just that I knew the diagnosis from the very beginning, so it turns out that formally there was no violation of the law.
You need to bring, they said, only diapers, they have the rest. No questions asked, I'll bring it. The employees seem to be quite responsive and sincere people. But still... such a baby especially needs a family, I think so. And there is very little hope for adoption, as the doctors there suggest, based on their work experience. The child is still registered for HIV (2 months old boy), the mother was a drug addict, there are 2 sisters...
Relatives, I specifically found out, do not visit. As far as we have been able to find out, even those who initially thought about taking the baby are no longer thinking about it.
For objective reasons, I can’t take the child with me (I have three children, there’s not enough money for them, and even in the fall-winter-spring, almost all the time someone from kindergarten or school brings in a cold... it’s dangerous... this is for such a child, as I understand it). Yes, and subjectively too (my husband, alas, is categorically against adoption).
I searched on the Internet for some family orphanages for children with HIV - it was as quiet as a tank. Here in Omsk, I haven’t heard anything about such people either. The names of those who have already adopted HIV-positive children, naturally, are not disclosed in the interests of the children. As a matter of fact, I don’t know how to talk to those who might want to adopt/arrange for guardianship (you’ll have to write down the child’s name and what hospital he’s in, so that people can somehow designate in guardianship who exactly they want adopt). It’s illegal to disclose the baby’s name and diagnosis. For this reason, I don’t risk starting a topic on the local forum yet. The world, alas, is sometimes too small.
At the same time, I really want adoptive parents or at least guardians to be found for the baby.
Maybe someone can advise what can be done in such a situation? How can I help in any way?

Promote the boy on adoption forums, write to otkatniki.ru. As far as I understand, the child has an HIV contact and the mother was not officially married?
The only alarming thing is the low weight and the lack of weight gain while on a bio-addict. This may be nothing, or it may indicate very bad consequences for the child.
If you want to help the boy, promote him, ask those interested to write to you in a personal message or email, and then you will give more detailed information about the boy and guardianship, where to contact.

And one more thing... if you want to help, do not write that the boy has HIV if he is only a contact. An unconfirmed HIV test (exposure) is not a diagnosis or a disease.
The presence of sisters who are already in the families of relatives, in general, does not in any way interfere with adopting a baby. the presence of relatives, too, if the single mother died or abandoned the child.

See what you can do for this child:

1. You know where it is. This means that you know the guardianship to which this hospital is attached, where he lies. You can go to guardianship and explain that the fate of the child (full name, date of birth - they should already have data on him) is not indifferent to you. Therefore, ask them for permission to post information about the boy on a specialized forum http://mdr7.ru/index.php - here parents, future parents, sympathizers, volunteers talk about children with such diagnoses.

2. Are you sure that he is HIV+ or is it still unknown? The fact is that perinatal contact with HIV does not automatically mean transmission of the disease from mother to child. The child may simply have positive tests, because... These are antibodies to HIV and HepC, and they usually (if there is no disease) disappear within a year and a half.
Usually children undergo ELISA tests - they should be positive for HIV and HepC contact. And then they do a PCR test - if it is negative, then they do this test after another 3 months, if it is negative, then the child is 99% healthy, but to be sure, they are monitored for up to a year and a half.
You can offer this center to pay for PCR tests if they do not want to do it themselves. And if it is negative (even the first), then this is a big increase in the chances of finding future parents for the child.

Although, alas, he probably has many other diagnoses. Do you know how low he was born? For what period?

Girls, thank you very much for your advice. I'll try to go to the guardianship. Without their permission, of course, it’s scary to promote a child on adoption forums. I also read about low weight and poor weight gain in mothers with HIV that this, alas, can be a sign of those very “bad consequences” for the baby. And the doctors, as I understand it, assume that it’s still a plus. But no one can say for sure yet, of course.
I was born on time and weighed 2400 at birth, in my opinion.
I’ve already read about removal/confirmation of an HIV diagnosis. PCR, in my opinion, does not always show the correct results (in my case, instead of the definitely existing papillomavirus, PCR showed herpes type II, which I have never suffered from and which was not confirmed by ELISA). So, probably, finally and irrevocably, everything will be clear only after 1.5 years based on the ELISA results.

Py.Sy. I understand about the wording “contact with HIV”. I'll keep this in mind for the future.

From SanPin "4.5.1. To diagnose HIV infection in children under 12 months of age born to HIV-infected mothers, methods are used aimed at identifying HIV genetic material (DNA or RNA). Obtaining positive test results for HIV DNA or RNA HIV in two separate blood samples from a child older than one month is laboratory confirmation of the diagnosis of HIV infection. Receiving two negative test results for HIV DNA or HIV RNA at the age of 1 - 2 months and 4 - 6 months (in the absence of breastfeeding) argues against it. presence of HIV infection in the child, however, the child may be removed from dispensary registration due to intranatal and perinatal contact with HIV infection after the age of 1 year."

A child born to an HIV-infected woman is observed at the Center for the Prevention and Control of AIDS with a diagnosis of “Perinatal contact due to HIV infection,” which corresponds to code R75 according to ICD-10. Subsequently, depending on the detection of HIV infection in a child, he is either removed from the register or transferred to the register with a diagnosis of HIV infection.

Medical examination of children born to HIV-infected women is extremely important from the first days of life. With timely medical examination, several tasks can be achieved:

1. Maintaining the child's adherence to zidovudine (for the purpose of postnatal prevention of mother-to-child transmission of HIV)
2. Prevention of Pneumocystis pneumonia
3. Counseling on cessation of breastfeeding
4. Detection and monitoring of side effects
5. Early diagnosis of HIV infection
6. Deregistration of a child

For postpartum prevention of mother-to-child transmission of HIV, starting from the first 8-12 hours of life, the newborn receives zidovudine syrup 2 mg/kg every 6 hours (or 4 mg/kg every 12 hours) for 4 weeks. For premature babies with a gestation period of 35 weeks or less, zidovudine is prescribed in the same dosage, but with a different frequency: for a gestation period of less than 30 weeks - 2 times a day; with a gestation period of 30-35 weeks - the first two weeks of life 2 times a day, and after - 3 times a day 1.

Prevention of Pneumocystis pneumonia is carried out for all children with perinatal contact with HIV infection from 4 weeks of life to 4 months; further need is determined depending on the presence/absence of HIV infection 2 .

Commitment, i.e. compliance with the medication regimen depends entirely on the mother or person caring for the child. It is necessary to strictly adhere to the prescribed time for taking medications and observe the dosage. A single dose of zidovudine in syrup for a newborn is recalculated regularly with an increase in body weight by 10% 1 .

Breastfeeding issues, in most cases, are discussed with an HIV-infected woman during pregnancy. It is important that the patient independently and consciously decides to refuse breastfeeding. If a woman decides to breastfeed, counseling is necessary based on the principle of “harm reduction,” i.e. Explain to her how the risk of infection of the child can be minimized.

To identify the side effects of zidovudine (anemia, toxic effects on the liver), early diagnosis of HIV infection and determine the criteria for deregistration within the prescribed period, a clinical and laboratory examination of the child is carried out.

It is necessary to strive for the earliest possible determination of the child’s HIV status for the timely initiation of antiretroviral therapy. Carrying out PCR contributes to the early diagnosis of HIV in a child:

• HIV infection is diagnosed if there are two positive results taken at least 1 month apart, regardless of the child’s age. At this stage, the infectious disease specialist may decide to prescribe combination antiretroviral therapy to the child.
• If there are two negative PCR results in a child who does not receive breast milk, it is highly likely that there is no HIV infection in the first months of life

According to Order of the Ministry of Health and Social Development No. 375, the determination of antibodies to HIV by ELISA (and immune blot if ELISA is positive) is carried out at the age of 9, 12, and, if necessary, 15 and 18 months:

• A positive result is confirmed by determination of antibodies to HIV using the immune blot method at the age of 15 and 18 months
• The absence of HIV infection is evidenced by two or more negative tests for antibodies to HIV (immunoglobulin G - IgG), carried out in a child over 12 months old, with an interval of at least 1 month between tests, as well as the absence of other clinical and/or virological laboratory signs of HIV -infections

Removal from the dispensary register of a child born to an HIV-infected woman, according to Order of the Ministry of Health No. 606, is carried out if all the following criteria are met:

• Age 18 months
• Negative test result for HIV antibodies using ELISA
• Absence of hypoglobulinemia
• Absence of clinical manifestations of HIV infection

It must be remembered that children born to HIV-infected mothers undergo medical examination not only at the Center for the Prevention and Control of AIDS, but also, like everyone else, are observed in the clinic at their place of residence. This observation includes:

• Examination by a pediatrician with mandatory anthropometry and assessment of physical and psychomotor development once every 10 days during the neonatal period, and then monthly until deregistration.
• Examination by a neurologist, otorhinolaryngologist and dermatologist - every 1 month, then every 6 months until deregistration.
• Examination by a surgeon, orthopedist and ophthalmologist - at 1 month and at 1 year.

After the child is removed from the register due to perinatal contact due to HIV infection, he undergoes further medical examination, like all children, only in the clinic at his place of residence. There are no special features when observing such a child.

1. Clinical guidelines for the prevention of mother-to-child transmission of HIV infection. Federal State Institution RKIB MH and SR RF, FSMC AIDS, 2009 ()
2. Clinical observation, care and treatment of children born to HIV-infected women and children with HIV infection: A short guide for specialists of AIDS prevention and control centers. – M., 2006. – 108 p.

HIV infection. In my opinion, no other disease causes more fear in potential parents. Most people still perceive an HIV-infected person as a direct threat to life, as a death sentence that is “final and not subject to appeal.” In many ways, this fear is generated by the lack of information about this disease.

In our region, children born to HIV-infected mothers live in the most ordinary orphanages and orphanages, and this is a great achievement; it was made possible thanks to the active work of the Murmansk AIDS Center and the support of the Ministry of Health and Social Development and the Education Committee of the Murmansk Region. Unfortunately, in our country there are still certain regions in which such children are doomed to live within the walls of children's infectious diseases hospitals; children's institutions refuse to accept them; they do not receive proper communication, development, or education.

Among the children in the social system of our region, there are several children with a confirmed diagnosis of HIV+, and significantly more children to whom the disease was not transmitted to their mother, but in their personal files there remains a terrible entry - “HIV contact”, which scares away so many potential parents. Despite this, I would like to note that our situation with placing HIV-contact children and even HIV+ children in families has already moved forward. Potential parents now, unlike, for example, a few years ago, have access to information regarding this disease. Increasingly, quite competent articles and stories appear in the media, the main goal of which is to convey to the audience information about the essence of the disease, about the routes of its transmission, about new achievements in the field of HIV treatment.

Let's figure it out, HIV infection and HIV contact, what is the difference? Is it dangerous to accept a child with such a diagnosis into a family? What do parents need to know if they are thinking about adopting an HIV+ child into their family?

So, let's begin.
AIDS (acquired immunodeficiency syndrome) is a disease, the consequence of which is a decrease in the body's protective abilities (immunity), and its cause is a sharp decrease in the number of lymphocyte cells, which play a central role in the body's immune system.

The culprit of this disease is the human immunodeficiency virus, abbreviated HIV (HIV), which gives the name to the initial stage of the disease as HIV infection. This virus was discovered relatively recently, in the early 80s of the last century, but through the efforts of scientists it has now been studied quite well.

HIV is unstable in the external environment. The virus dies very quickly when boiled (after 1-3 minutes), and is almost completely inactivated by heating at a temperature of about 60°C for 30 minutes. It also dies quickly under the influence of disinfectants commonly used in medical practice (3% hydrogen peroxide solution, 70% ethyl alcohol, ether, acetone, etc.).

It is possible to become infected with HIV in several ways: sexually, parenterally (through blood) and vertically (from mother to fetus). The source of infection is an HIV-infected person at any stage of the disease.

At a certain point, the virus is activated, and the rapid formation of new viral particles begins in the infected cell, which leads to the destruction of the cell and its death, while new cells are damaged. Unfortunately, HIV is partial to those cells that participate in the formation of the body’s immune response. With such a defeat, a situation arises in which the cells that guard the body not only do not help in the fight against foreign agents, but are themselves recognized by the immune system as foreign and are destroyed. There is a gradual destruction of the human immune system, which becomes defenseless against infectious diseases, including those that normally do not pose big problems for the immune system and are not at all dangerous.
According to the Moscow AIDS Center, today the probability of giving birth to an infected child from an HIV-infected woman is on average about 30%; this figure is influenced by many factors, one of the main ones being the woman’s viral load (in other words, the concentration of the virus in her blood). However, provided that a pregnant woman carries out preventive measures prescribed by a doctor, the risk of giving birth to an HIV-infected child can be reduced to 1-5%.

This means that out of 100 children born to HIV-infected mothers, up to 99 children will be healthy. I repeat, this is possible if a woman follows the doctor’s recommendations during pregnancy. Unfortunately, women whose children end up in orphanages and orphanages often do not adhere to these recommendations; they may not be registered as pregnant at all and may not receive treatment for HIV infection. In this case, the percentage of transmission of HIV infection from mother to child increases significantly.
How is HIV infection diagnosed in children? When can you understand whether the virus has been transmitted from a biological mother to a child?

Soon after birth, it is impossible to answer whether the baby is infected or not. This takes some time. Most often, antibodies to HIV are found in the blood of newborns, transmitted passively by the mother, which subsequently disappear from the child’s body as he grows. This means that the child is not infected.

Children whose HIV-infected mothers passively transferred antibodies to HIV to them) are considered HIV-contact. They are observed at the AIDS Center and children's clinic at their place of residence, and undergo the necessary tests there to timely monitor whether maternal antibodies are leaving the child's blood. This condition, according to the International Classification of Diseases (ICD-10), is designated as an inconclusive test for HIV.

These children make up the majority of children born to HIV-infected mothers. As the child grows, maternal antibodies are destroyed and, usually after 1.5 years of age, laboratory tests for HIV infection are negative. In this case, children are removed from the dispensary register. Sometimes maternal antibodies disappear a little later, then the period of observation of the child can be extended.

In accordance with Order No. 606 of the Ministry of Health of the Russian Federation dated December 19, 2003, to deregister a child at the age of 18 months. the following conditions must be present:

• negative test result for antibodies to HIV infection
• absence of clinical manifestations of HIV infection.

If the tests show that the child is still infected, then upon reaching 1.5 years of age he is diagnosed with HIV infection, he continues to be observed by specialists at the AIDS Center, and, if necessary, therapy is selected for him. The diagnosis can be confirmed in a child at an earlier age in the presence of clinical signs of HIV infection and the results of additional specific studies. With proper treatment and timely use of medications, the prognosis for HIV+ children is favorable.
Thus, if you liked a child in the database, you called or came to an appointment with the guardianship authorities and they tell you that the biological mother of this child is HIV+, do not rush to conclusions, take a referral for the child, go to the Children's Home, check there , how many times the child has already been tested for HIV infection. Pay attention to the age of the child; children are usually tested for HIV at 3-6-9 months and then every 3 months. I strongly advise that if you like a child whose profile says HIV contact, HIV infection, etc., be sure to sign up for a consultation at our AIDS Center. There you can get answers to all your questions from those who have experience, qualifications and, in addition, monitor this particular child from birth specifically for HIV infection.

If as a result you find out that the child you like is HIV+, the diagnosis is confirmed, this is not the end either. You shouldn’t fall into hysterics and bury a child alive in your imagination. You need to pull yourself together and think calmly.

1. HIV + child is NOT INFECTIOUS to others, he does not pose the slightest danger to you, to your natural children, etc. There is no HIV infection in the home. If there had been at least one case of infection in this way, there would have been no Federal laws or orders from the Ministry of Health stating that there are no restrictions when communicating with such people.
2. An HIV+ child can attend kindergarten and school just like all other children; you have the right to non-disclosure of the child’s diagnosis in these institutions. The law protects the secrecy of the diagnosis; in our city, HIV+ children attend kindergartens and schools, and no one has had any problems. In our city, medical care for HIV+ children is organized very well, no one will point a finger at you, every clinic has HIV+ children registered, you will not be the first and the last, these children are no longer wild!
3. There is an AIDS Center in Murmansk that monitors children from all over the Murmansk region. Here your child will be registered and undergo tests once every 3 months; all the center’s specialists are very friendly, always ready to help you and give advice. The center employs psychologists (t. 473299), an infectious disease specialist (t. 472499), a pediatrician (t. 473661), and a social worker.
4. If, according to clinical and laboratory data, the child needs special treatment, it will be prescribed in a timely manner and absolutely free of charge (for life!). Most often, children take medications 2 times a day, morning and evening. Medicines for children are most often in the form of syrups, provided that the therapy is successfully selected, children tolerate it well, side effects are rarely observed. Children are active, lead a very normal lifestyle, can play sports, etc. These are the most ordinary children.
5. Then, when the child reaches adolescence and realizes his diagnosis, a very important moment will come. The child must clearly understand how he differs from his peers. What he can and cannot do, unfortunately. What can he not do? He cannot be a blood or organ donor, and he must take a very responsible approach to choosing a partner to start a family. As for choosing a partner, HIV-infected people can create couples. Moreover, the child will be able to give birth to a healthy grandson or granddaughter. Many people do not understand that an HIV-infected woman can give birth to a healthy child. The risk of transmission of the virus with complete prevention may be less than 1%. A family can raise an HIV-infected son or daughter and receive healthy grandchildren.
6. For us, northerners, the issue of summer holidays is relevant. Your family is used to traveling to hot countries in the summer; won’t this be harmful for the HIV+ child? HIV-infected children can go to the sea in the summer, swim and relax peacefully. The only thing is that it is not recommended for them to deliberately lie in the open sun or purposefully sunbathe. Agree, active tanning is not recommended for all northern children. It is advisable to ask your child to wear a light T-shirt and a hat.
7. Does an HIV-infected child need a special diet? What can and cannot be eaten? In principle, you can eat anything, but there are small restrictions when taking medications (for example, you cannot drink grapefruit juice or infusions of certain medicinal herbs, as they can react with therapy and reduce its effectiveness).

An HIV positive child can be compared in many ways to a child with diabetes: the child receives medication 2 times a day. Your task as a parent is to love your baby, make sure that the child receives medications on time, sleeps more, walks, and eats properly and nutritiously. And that's basically it.

If they receive therapy, such children will live long, create their own families and give birth to children. According to my observations, the absolute majority of HIV+ children are very beautiful, as if nature, due to their bright, extraordinary appearance, wants to give them an extra chance to find a family.

Think about it, if you like a particular child, perhaps his HIV infection is not at all a reason to shed tears and abandon him. Give him a chance, and the child will thank you three times with his love!

Hello, dear readers!

I didn’t think long about the next topic for the blog; life itself gives me ideas.

I do not even know where to start? Probably necessary from the very beginning. When Andryushka was almost two years old, I really wanted a second child. This desire was so strong it brought me to tears. Everyone tried to dissuade me, saying that it would be very difficult. Indeed, it was hard!

My husband warned me that he was working, so he wouldn’t be able to help either. He spoke, but still helped, thank him very much! He doesn’t read my articles, but I know that many understand and see what a special person he is.

We were looking for a boy again, then there was a story with Denis, a boy from Kazakhstan... So, I was sitting one evening, and Ksenia Igorevna sent me a message: “Anya, help me find a home for a child, a boy!” I ask what it means to “place”, because we are also looking for a boy! The answer was: “The child has HIV contact.”

Going back, I will say that before taking our first baby, we were categorically against four diagnoses: HIV, hepatitis B and C, and we were also not ready to take a child with unpreserved intelligence. After Andryusha appeared in our family with exposure to hepatitis B and C, and then the diagnosis was not confirmed, of course, we were no longer afraid of hepatitis.

There were two diagnoses left that we were “afraid of.” And now I’m sitting in the kitchen, my husband is at work again at night, identical to the first situation, when I studied the history of hepatitis, and I understand that there is a real child whom we can take, but he may have HIV. You know, at that very moment I was very scared that my husband would say “no.” This was my only fear.

I sat down and read everything about this diagnosis overnight, because the idea needs to be “sold” to my husband, with compelling counterarguments, otherwise the business may fail. This is how I prepared to offer my husband to adopt a child, this is what I did when we took Andryusha, so I confidently recommend this tactic to everyone, it works 100%. I will write a separate detailed article about this if necessary.

After studying this question, I realized that:

1. It is important to follow safety measures, but the percentage of infection in domestic conditions is so small, honestly, it is simply insignificant; there are only a few such cases.
2. HIV is transmitted sexually and infection is possible. If the child is born naturally, the percentage is small.
3. Infection is possible when breastfeeding - the probability is less than one percent!
4. The child needs therapy: he must be given medicine every day at a strictly defined time, if the diagnosis is confirmed.
5. Tests must be retaken every six months, and after two years - once to confirm or remove the diagnosis.
6. There is a very small percentage that HIV contact (this is the reaction of the child’s antibodies to the HIV of the birth mother) will be confirmed.
7. Such a child must be raised with the understanding that he must take care of his sexual partner all his life and use protective equipment during sexual intercourse.
8. Such children can have absolutely healthy children.
9. Children whose diagnosis is confirmed are called “plus children.”
10. Almost all adoptive parents of plus children take a second child, also a plus child, and I understand them.
11. “Plusiki” are very “profitable” for orphanages, because these are ordinary children with preserved intelligence, who only need to put a pill in their mouth once a day.

In our environment there are people with this diagnosis, some do not take therapy at all, some do it only when titers are high (indicators of disease activity in the blood). They have wonderful families and wonderful healthy children! I may not be very precise in terms, I apologize right away. And someone can correct me, but the essence will remain the same.

...I return to that moment when I am sitting in the kitchen at night. I asked Ksenia Igorevna what other diagnoses the baby has? It turns out that there are no diagnoses, even the baby’s Apgar score was 7 at birth!

I immediately called my husband, said that there was a child, and informed him about the diagnosis. The husband said: “You're crazy! Of course not! Anh, we already have a child, but what if he gets infected? We can't take that risk." In general, we talked for more than an hour, I was already savvy, so the “fight against objections” in my performance was carried out with an “A+”.

By the way, my husband didn’t resist for long. I agreed, and we went to see the child. I remember we went into the room, they brought him. At this time, the chief doctor came to the pathology department and carefully began to talk about the diagnosis. My husband calmly turned to her and said: “Yes, we already know everything. And the decision was made. Today we came to get acquainted, as soon as we have the opportunity, we’ll pick up the child right away.”

We were also told that Daniil tolerates antiviral therapy very poorly and often vomits. I don’t know, maybe the hospital deceived us, or maybe he really was just spitting up milk. We took him home, and two or three times a day he vomited after feeding so that everything he ate came out. Sorry for such details, but this is also an important experience, maybe it will help you.

Classical homeopathy and our wonderful homeopath helped us; she chose the right drug. By the way, the drug turned out to be the same as Andryusha’s when we contacted him for the first time, he was then eight months old. Then the homeopath said that this drug is called “the drug for abandoned children.” .

When we went to donate blood for the second time, Daniil was 8 months old. The result was negative again - the second time. For a long time, the doctor at the Contact Center could not understand how this is so: we do not drag the child to hospitals to be weighed, we have a medical exemption from vaccinations. We just decided for ourselves that our children will grow up without vaccinations.

Well, actually, the last time we donated blood was three weeks ago. It was very difficult for me psychologically, because the child’s blood is taken without the presence of the mother. And this is probably correct, because often mothers also have to be resuscitated...

Of course, for Daniil, who was in the hospital twice in two and a half years - at birth and for examination for adoption documents - donating blood from a vein is a serious test. I cried very hard on my husband’s chest while our son screamed behind closed doors: “Mommy, mommy...”

It's a child's cry for help that you can't respond to. Of course, they later carried Daniel out to us, of course, we hugged and cried with him for a long time, but I sincerely wish all mothers and children not to be separated even for these three minutes, they seem like an eternity.

The day before yesterday I received the test results, the doctor congratulated me that my son was healthy. In the office, I asked in detail whether it was possible to breastfeed such babies, and it was she who told me that the mother’s chance of becoming infected is less than one percent.

I was very upset, because I so dreamed of establishing breastfeeding, again my husband did not allow it because of the child’s diagnosis, and again the diagnosis was not confirmed. There’s a woman’s intuition, why didn’t I insist!

The doctor didn’t know that it was possible to adopt and establish breastfeeding; for those who didn’t know, this is good news! In our city there is at least one such mother with many children; she took a little girl into the family when she already had two children of her own, and established feeding, feeding her daughter for a very long time. As you can see, nothing is impossible!

I left the doctor’s office and took out the certificate again. I sent the photo to my husband, and only then did my tear dam break. I realized how merciful God is, how lucky our Daniel is, what a miracle happened in our family! I wasn’t afraid of the diagnosis, I wasn’t and am not afraid of difficulties, but I understand how much easier the path is without such a disease.

After all, in our country this is a label for life, everyone runs away from such people like the plague. Recalling that day with my husband, I reminded him that we could have abandoned our gray-eyed miracle. The husband said: “I’m afraid to even think, how could we live without him?” And indeed it is. After all, over time, the line between friend and foe is erased, and adopted children become more than their own.

The most important tasks when working with children born to HIV-infected mothers are chemoprophylaxis of HIV infection and complete medical examination, including for the purpose of early diagnosis of HIV infection, prevention of opportunistic infections, selection of the optimal vaccine prophylaxis regimen, timely prescription of antiretroviral therapy .

A child born to an HIV-infected woman is subject to registration under code R75, “Laboratory detection of human immunodeficiency virus [HIV]. (Inconclusive test for HIV detected in children)” International Statistical Classification of Diseases and Related Health Problems, Tenth Revision. If a child born to an HIV-infected woman is not tested for HIV by laboratory methods, he is registered in accordance with code Z20.6 “Contact with a patient and the possibility of infection with the human immunodeficiency virus.” In both cases, a diagnosis of “Perinatal contact due to HIV infection” is made.

The following groups of children born to women are subject to testing for HIV infection:

with HIV infection;

who were not registered with the antenatal clinic during pregnancy;

not tested for HIV before or during pregnancy;

injecting drugs intravenously before and/or during pregnancy;

having sexual partners who inject drugs intravenously;

who had sexually transmitted diseases during pregnancy;

suffering from viral hepatitis B and/or C.

In addition, children without parental care are subject to HIV testing.

Dispensary observation of a child who has perinatal contact with HIV infection is carried out by a pediatrician at an outpatient clinic network or any other medical and/or social institution together with a pediatrician at the Center for Prevention and Control of AIDS. In the process of dispensary observation, the following is carried out: diagnosis of HIV infection, confirmation of the diagnosis or removal from the dispensary register; observation of the child by a pediatrician and medical specialists; conducting standard and additional laboratory tests; prevention of Pneumocystis pneumonia; assessment of physical and psychomotor development.

Medical examination of children born to HIV-positive women should be carried out by specialists with experience in this field, using all modern methods of diagnosis, treatment and monitoring of HIV infection and HIV/AIDS-related diseases. Outpatient, emergency and advisory care for children born to HIV-positive women is provided by children's clinics at their place of residence on a general basis. Specialized care for children is provided by specialized hospitals in the direction of children's clinics and/or Centers for the Prevention and Control of AIDS.

Table 3. Observation schedule for children born to HIV-infected women

Table 4. Schedule of laboratory tests in children born to HIV-positive women

1 study of the immune status is carried out after receiving positive results of a test for HIV using the PCR method. If the latter is unavailable, it can serve as one of the diagnostic criteria (a decrease in the number of CD4(+) T-lymphocytes is a characteristic manifestation of HIV infection);

2 is optional;

3 in children receiving chemoprophylaxis of Pneumocystis pneumonia with Biseptol;

4 the following study: if the result is negative - after 1 month and if the result is positive/uncertain - after 3 months (if the PCR method was used to diagnose HIV infection).

If HIV nucleic acids are detected in a child by PCR and/or clinical signs of HIV infection, an in-depth examination is carried out: determination of HIV status, immune parameters, quantitative determination of HIV RNA in blood plasma (“viral load”), identification of HIV-related diseases, and The issue of therapy, including antiretroviral therapy, is also being addressed. Vaccination of an HIV-positive child is carried out at the place of residence in accordance with the recommendations of the pediatrician of the Center for Prevention and Control of AIDS.

A child with HIV infection routinely visits the Center for Prevention and Control of AIDS once every 3-6 months, depending on clinical and laboratory parameters. In the early stages of HIV infection, with normal CD4 lymphocyte counts, clinical examination is carried out at least once every six months; in late stages and with reduced CD4 lymphocyte counts - at least once a quarter.

A child born to an HIV-infected woman is removed from the dispensary register on a commission basis in the absence of clinical and laboratory signs of HIV infection. When deciding whether a child is HIV-infected, the child’s medical history, development, clinical condition, results of laboratory tests for HIV infection, the child’s age, and lack of breastfeeding are assessed.

The final decision about the absence of HIV infection can be made on the basis of negative results of determining antibodies to HIV. The minimum period of observation of a child in the absence of HIV infection should be at least 12 months from the moment of birth or cessation of breastfeeding, subject to adequate diagnostic tests, including virological methods. If monitoring is carried out by serological or less than two virological methods with established examination periods, the child can be removed from the register if HIV-negative at at least 18 months of age.

If HIV infection is detected in a child, he remains registered for life. In practice, children whose diagnosis of HIV infection has been removed, but living in families with HIV-infected parents, will continue to be monitored through contact.