Spread of HIV infection from a woman who has transmits HIV to her child during pregnancy, childbirth (labor and delivery), or breastfeeding (breast milk) is called as  Mother to child  transmission (MTCT) of HIV. It is also termed as the perinatal transmission of the HIV infection or  vertical  transmission. In the absence of medical intervention, perinatal transmission rates are very high, between 20-45% in different parts of the world. In various regions of the African subcontinent a large number of HIV infected children are present. It is a major cause of deaths in teens and adolescents in that region. 

Almost 90% of all HIV infected children live in the sub-Saharan Africa. In some districts of AP, Karnataka, Maharashtra and TN that were highly HIV-prone, we have several HIV infected children and adolescents. The virus replicates in the body and affects the immune system. Due to decreased immunity, various opportunistic infections enter the body and cause AIDS related symptoms. Prevention of HIV infection in infants and young children is now a high priority and has been the rallying point for enhanced prevention efforts. MTCT HIV infection can be prevented with adequate measures by way of Anti-retroviral treatment (ART). All expecting mothers who are HIV infected should have access to the preventive medical services throughout the gestation period, during labor and also during breastfeeding. 



Proper provision of resources with skilled staff and awareness programs can help in avoiding new infection cases. Breastfeeding is the primary source of transmission of infection from mother to child. Basically, once ART is started in an HIV infected pregnant woman that should continue forever. With proper ART course, chances of MTCT are near Zero. At the Unison Medicare & Research Centre; which is India s first fully comprehensive clinic for HIV Care and infectious Diseases, during last decade, not a single MTCT has occurred after treating more than 160 such HIV infected mothers. Even prior to that MTCT rate was lower than 1%. Our motto has been making the mothers virally suppressed commensurate with the global principle of  Undetectable = Untransmittable ! In fact now more and more HIV infected couples have been coming forward for an elective pregnancy. Even HIV un-infected children orphaned by AIDS or living with sick caregivers are at the great risk of emotional and physical abuse, which in turn increases the child s vulnerability to HIV infection. 

Reduction of risks to these vulnerable children is of great importance and various programs are being implemented for the welfare of orphans and vulnerable children. Various risk factors that are implicated in the transmission of HIV infection from mother to child are as follows: 

Increased viral load 
Genital tract viral load 
Reduced CD4 cell count 
Unprotected sexual intercourse with infected partner 
Smoking, Substance and drug abuse 
Deficiency of Vitamin A and other essential nutrients 
Presence of other Sexually transmitted diseases (STDs) 
Pre-term delivery 
Placental disruption 
Invasive monitoring of the fetus 
Breast feeding In most cases, HIV will not cross through the placenta from mother to baby. 
In an otherwise healthy mother, risk of child getting infected is low. Prenatal visits shouldn t be increased until a complication arises. The physician should observe symptoms of AIDS and pregnancy-related complications on a regular basis. HIV may be the direct cause or a marker of a complex interaction of related medical and social conditions that affect pregnancy. Most HIV positive women are usually asymptomatic and have no major obstetrical problems during their gestation period. They should receive similar obstetric antenatal care as the HIV-negative women, unless indicated by the need to provide specific treatment for HIV related conditions. There is no evidence of a need to increase the number of antenatal visits, provided there are no complications of the HIV infection, although additional counseling sessions may be required to reassure the mother and family. 

Care of the HIV positive woman during pregnancy should include ongoing counseling and support as an integral part of the management. Invasive diagnostic procedures, such as chorionic villus sampling, amniocentesis or cordo-centesis should be avoided wherever possible, due to a possible risk of infection of the fetus. In case you have a concern or query you can always consult an expert & get answers to your questions!

How Can We Achieve HIV-Free Generation?

Tuberculosis is an opportunistic infection caused by the bacteria Mycobacterium tuberculosis. The infections occurring in people with weak immunity as compared to the people with a healthy immune system are called as opportunistic infections. As, HIV enters the human body, it replicates and weakens the immune system which in turn increases the risk of contracting Tuberculosis in people already suffering from HIV infection.

An HIV and Tuberculosis co-infection occurs when an individual has both, the HIV infection and an either latent or active TB disease simultaneously.  Each disease acts in speeding up the progress of the other, when HIV and TB infection is present together in the body. HIV infection speeds up the progression from latent to active Tuberculosis, Mycobacterium tuberculosis also accelerates the progression of replication and spread of the HIV infection.

HIV infection and Tuberculosis are totally different type of infectious diseases. HIV is a viral infection and TB is a bacterial one. An HIV infected person will not contract TB unless a contact happens with a TB infected person. TB spreads via droplet infection and is communicable. If a person lives in a country with a high prevalence rate of TB, an HIV patient is highly susceptible to contracting the infection. In the similar manner, a person suffering from TB gets infected with the HIV infection only through the blood and bodily fluids borne route, with unprotected sexual intercourse with an HIV infected individual being the most important cause.

Amongst all the other opportunistic infections, TB occurs at an earlier stage in the course of an HIV infection than most other opportunistic infections. Mortality rate in the co-infected patients is more than twice that of HIV infected individuals without a TB infection. Even if a patient is undergoing anti-retroviral therapy, the death rates remain high in co-infected individuals.The natural history and course of TB gets altered in people with an infected immune system. The damage to immunity due to HIV infection causes a drastic reduction in the pathogen killing capacity of the body. In such patients if there is no anti-retroviral treatment prescribed, then the latency period between the infection and progression of disease gets eliminated. 

An active phase of TB is observed in such individuals progressing within a short span of time, ranging from weeks to months, rather than years as it normally should be spanning. Risk of progression from a latent stage to an active stage of TB is around 10-15 times greater in an HIV infected individual as compared to the non-infected person. Such individuals also communicate the disease more rapidly to others.Pulmonary tuberculosis in an HIV infected person can present similar symptoms like that of a classic TB disease. However, a co-infection can sometimes show less presenting TB symptoms, where even the chest X-ray scans can be observed to be normal. A  subclinical  phase of Tb in co-infected patients can cause delay in the diagnosis of the symptoms and subsequently affect the prognosis due to lack of timely treatment.

Social stigma and discrimination has caused an obstacle in provision of adequate treatment for people with HIV. Proper counseling  and initiatives taken to provide indiscriminate care can aid in identification of co-infection and earlier stages. Anti-retroviral treatment teamed up with anti-tubercular drug regimen is prescribed and a successful treatment for drug sensitive cases of TB can be provided with medications for 6-8 months.

How HIV & TB  Are Related?

Sadly, there is no known cure for hiv. However, it can be controlled through medication. Hiv or the human immunodeficiency virus attacks the body's immune system and over time leaves it vulnerable to a number of other diseases. In its most advanced stages, it can lead to aids. Hence, it is essential to control this virus in its early stages.

Hiv treatment is known as antiretroviral therapy or art. This involves taking a series of hiv medicines on a daily basis. Art can help hiv patients live a longer, healthier life and can also reduce the risk of hiv transmission.

The first step towards getting treated for hiv is to get tested. This can be easily done at your nearest health center and the results will be kept confidential. With hiv prevention is better than cure and hence, if you have more than one sexual partner, you must insist on them getting tested as well.

As soon as you test positive for the virus, start the treatment. Do not wait till you start feeling sick. Art can be taken by anyone at any stage of the condition. If you are pregnant, breast feeding or have been diagnosed with early hiv infection, this is all the more important.

Hiv medication works by preventing the hiv cells from multiplying and thus reduces the amount of hiv cells in the body. A low level of hiv cells gives the immune system a chance to recover and strengthen itself. A lowered hiv count also reduces chances of transferring the virus to another person.

Art involves following a regimen of a number of medicines. There are 25 hiv medicines that can be grouped under six drug classes depending on how they affect hiv cells. These include:

1. Nucleoside reverse transcriptase inhibitors
2. Non-nucleoside reverse transcriptase inhibitors
3. Protease inhibitors
4. Fusion and entry inhibitors
5. Pharmacokinetic enhancers and
6. Integrase strand transfer inhibitors

Usually, a person is prescribed 3-4 hiv medicines from a minimum of 2 drug classes. A number of factors go into deciding what form of hiv treatment is most suitable to a patient. This includes the person's individual needs, symptoms presented, potential drug interactions and possible side effects. Convenience of following the regimen and costs are also taken into account while prescribing a form of treatment to a hiv patient.

Once treatment is started, art can be proven to be effective within 3-6 months by lowering the number of hiv cells in the body.

HIV/AIDS - How Can It Be Treated?

Oral sex is a form of sexual activity, which involves the arousal of one's genitalia by his/her partner using the mouth (tongue, lips and throat). It is also called Cunnilingus (performed on a female) and fellatio (performed on a male). It is done before intercourse and during foreplay for sexual arousal. It is safe as compared to vaginal or anal sex, the rate of getting a sexually transmitted disease or HIV is comparatively lower. 

Oral sex can spice up your life and can also make your partner reach orgasm. It is also a safe way of getting sexual pleasure without getting pregnant. But necessary precautions must be taken in order to have safe oral sex.

Some of these necessary precautions are:

1. You can get throat cancer from oral sex: Human papillomavirus (HPV) is a cancerous virus found in the body of infected people. This virus can be transmitted to the person with whom you are engaging in oral sex. Studies show that people who engage with more than 6 sexual partners at once are more prone to get oral cancer. It is advisable to get your partner tested for HPV virus before engaging in oral sex.

2. Oral sex also causes stress: Oral sex is generally related to hygiene, therefore the partner can be self conscious and worried about his/her genital hygiene. If oral sex is performed on a daily basis, some people prefer to wax their pubic hair often. This is harmful because it can cause red bumps and burning sensation occurs. It is advisable to trim your pubic hair and wash it properly before engaging in oral sex.

3. A condom should be worn by the male during oral sex so that there is no risk of male fluid entering the woman's body.

4. A latex, which is made into a thin sheet called dental dam can be used on the vagina or anus. This creates a thin barrier between the mouth and the genitalia. Hence, chances of getting infected by sexually transmitted diseases are greatly reduced.

Oral sex can be pleasurable and fun, but the risks of getting sexually transmitted diseases like herpes, gonorrhea and crabs is not altogether misplaced. So it is advisable to use proper protection and to maintain hygiene before engaging in oral sex.

4 Ways to Have Safe Oral Sex - Necessary Precautions

Don't Panic !

Having unprotected sex isn't the smartest move a person can make, but it isn't necessarily the end of the world, so follow the advice below and you should be fine.

We Had Unprotected Sex And...I Think I'm Pregnant

Finding out you're pregnant can be the happiest or the scariest day of your life.

Don't wait around and bury your head in the sand saying 'it won't happen to me' and 'I'll be fine' you might not be, and then you'll find yourself in a much more difficult situation than if you'd faced the situation head on and quickly.

If the intercourse happened less than 72 hours ago, emergency contraception, the morning-after pill, can be taken as a precaution against you becoming pregnant. However, note that the sooner you take the emergency contraceptive pill, the higher its efficiency is.

We Had Unprotected Sex And...I Think I Have an STI

Check for any unusual symptoms around your genitals (vagina or penis), such as:

Pain when you urinate
Itching
An unusual or smelly discharge
Sores
Unexplained bleeding
If any consult your healthcare provider immediately

Not all STIs have visible symptoms so even if you think you're fine, after having unprotected sex, get tested!

Go For Sexually Transmitted Disease Profile Including HIV ( 1ST Month HIV RNA, 3RD MONTH HIV ELISA), HSV 1 and 2, HbsAg, HCV, Urine Routine, VDRL, etc.

We Had Unprotected Sex And...I Think I May Get HIV

Take Post Exposure Prophylactic Drugs (Anti - HIV) as soon as possible. It works when started within 72 hours and must be continued for 1 month to prevent HIV.



What If You Have Unprotected Sex?

The human immunodeficiency virus or hiv is a virus which causes hiv infection and leads to" acquired immunodeficiency syndrome" or aids. Hiv is transmitted by different means and ways.


Unprotected sex is a primary mode of transmission of the hiv virus from an infected person to a healthy person. Unprotected sex refers to having sexual intercourse without using a condom or any other mode of protection. It leads to hiv transmission along with other sexually transmitted infections.


How does hiv occur from unprotected sex?
While having sex without protection, the hiv present in the body fluids such as blood, sperm, vaginal fluid, pre-cum or anal mucus of an hiv infected patient can pass on to the body of his/her partner. The transmission occurs through the membranes of the penis in men, vagina in women, the rectum and also through mouth and throat. It is more likely for an hiv patient to pass on the virus during the first few months after getting infected. This is because the virus spreads over body fluids during this stage.


Which types of sex are more risky?
Hiv is transmitted the most by having vaginal or anal sex. Anal sex accounts for being the riskiest because the lining present in the anus is much more delicate than the vaginal lining. It is prone to more damage, easily. There are two types of anal sex: receptive anal sex and insertive anal sex. Receptive anal sex is more risky.


Hiv can also be acquired from oral sex. This can happen in case the person giving oral sex has ulcers in the mouth, sore and bleeding gums. In case the person receiving the oral sex is already infected, the other person gets hiv.


A person who has sex with multiple partners regularly is at a high risk of getting hiv because of unprotected sex.


Prevention
Getting hiv from unprotected sex can be avoided if you use these precautions:


- condoms
Condoms offer the precaution against hiv infection from anal or vaginal sex. They should be used by men before any kind of sexual contact to restrict the passing of semen or fluid, which may be infected by hiv.


- lubricants
Sex is made easier by using lubricants and reduces the risk of tearing in the vagina or anus due to friction. The risk of a condom breaking is reduced using lubricants.


- dental dams
This is another precautionary device, which is a small sheet of plastic. It has to be placed to cover the mouth of the vagina or anus and reduce the risk of hiv transmission.
Unprotected sex is the primary cause of hiv and people who do not take precautions before sex are likely to be infected by hiv.

HIV and Sex

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