Why has my baby tested HIV positive?

Monday August 19 2019

 

By Dr Vincent Karuhanga

During my antenatal visits, I tested HIV negative. However, after one year, my child has tested HIV positive. Did the baby get the infection at the hospital? Angulo

Dear Angulo,
I wonder why doctors may have checked a one-year-old baby knowing that the mother was negative for HIV infection during antenatal care unless the child had symptoms pointing to an HIV infection.

Anyhow, doctors usually ask mothers attending antenatal care to come with their husbands for HIV checks. Then, if the husband is HIV positive, he is advised to use condoms to avoid transmitting the virus to his wife, especially during pregnancy when mothers are most vulnerable to infection, which they can easily pass on to their unborn babies.

If the mother tests HIV positive and the husband negative, this also helps protect the husband from infection. Both the husband and wife are also advised on how to avoid getting HIV infection if both are negative.

If you were found negative on two occasions and your husband was not checked yet he was infected or got infected later, he may have transmitted the infection to you. Also, you may have had an extramarital affair after being found negative hence getting infected during pregnancy and infecting the baby.
New infections during pregnancy come with high virus amounts in the blood, increasing the likelihood of infecting the baby. If you got infected during pregnancy without treatment, the baby has about a 25 per cent chance of contracting HIV and about 70 to 75 per cent during labour and delivery apart from risking transmitting the infection during breastfeeding.

Today, mothers who are discovered to be HIV positive during pregnancy just like any other mother who may not be pregnant, are started on antiretrovirals (ARVS) straight away or given ARVS just before caesarean delivery. The baby is also given ARVS within 72 hours of birth for at least a month. This is apart from avoiding breastfeeding or if breastfed, not given any other feeds (exclusive breastfeeding).

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HIV testing (HIV RNA and HIV DNA nucleic acid tests) for babies born to women with HIV is recommended at 14 to 21 days, at one to two months, and again at four to six months to find out whether the baby is infected. Infected babies have to be indefinitely continued on ARVS.
ELISA tests may be deceitful because if the mother has HIV infection, the babies may be positive for the first 18 months even when they are not infected. This is because newborns keep their mother’s antibodies until they produce their own at around 18 months of age when if they have no infection will then become negative.

Therefore, a positive test in a baby before 18 months may indicate the presence of the mother’s antibodies but not those of a child and wrongly declare the baby to be infected whereas not.

HIV transmission is mainly through unprotected sex and a mother with it infecting the unborn or breastfeeding baby. Please go for an HIV test since you may have got infected and then infected your baby.

My three-month-old baby gets constant bouts of flu and although I keep giving them piritex junior and Septrin syrups, there is no change. Which antibiotic is best? Anna
Dear Anna,
In Uganda, a runny or stuffy nose whether accompanied by fever or other symptoms or not may be referred to as flu and here antibiotics are wrongly given risking allergies and other side effects as well as creating antibiotic resistance.
An antimicrobial such as septrin can actually cause allergic reactions which can be worse than a mere common cold it may purportedly be given for. It is also advised that babies younger than six months should not be given cough syrups.

Flu actually refers to a common cold which is caused by any of the more than 200 viruses while influenza is a more serious condition caused by influenza viruses that includes bird or swine flu. It is common for babies under six months to have a blocked nose (‘snuffles’) due to normal mucus that collects in the nose. This is because the baby’s ability to clear the nose is not yet efficient. Snuffles are also common in newborns as they get used to breathing air and are not yet able to blow the nose and clear mucus.

Sometimes, a newborn, who is yet to get a strong immunity to resist various common cold viruses from visitors or school going children may also cause recurring common colds.

Allergies involve a “complex interplay of genetic predispositions and environmental factors and can happen when a baby is still in the mother’s womb hence creating sticky mucus in the newborn.

Eating a balanced diet throughout pregnancy and lactation is important. Specific restrictions of foods to prevent allergies is not advised since this has not been shown to prevent the future development of allergies in children with avoiding select foods during pregnancy actually increasing the risk of developing future allergies in infancy or childhood.

Generally, no treatment is required if the baby is having a stuffy or runny nose but is otherwise well and feeding well. Sucking mucus out of the newborn’s nose by the mother is also likely to introduce a flu virus or even bacteria.

Sometimes, nasal stuffiness or running can be associated with difficulties breathing through the nose apart from interfering with feeding, which requires a doctor’s attention but in most cases, salt (saline) drops can make it easier for the baby to expel the mucus and to dry the nose.

A cup of clean water mixed with a teaspoon of non-iodated salt can also do the trick and if not, a nasal aspirator can suck out the mucus.

Is it safe for a peptic ulcer patient to get involved in water fasting? This involves spending three days without eating any food but just taking water. Ndubabay4real

Dear Ndubabay4real,
Water fasting is the act of not taking food but only water. Whereas there are reported benefits, this kind of fasting can cause health problems including for people with gout and peptic ulcers. Peptic ulcers are largely caused by a germ called helicobacter pylori that infects the acid areas of the alimentary canal including the stomach and duodenum.

Contrary to local beliefs that peptic ulcers cannot be cured, the ulcers can be cured by taking drugs that reduce stomach acid production apart from prescribed antibiotics.

That said, those suffering from peptic ulcers apart from drug treatment require lifestyle modifications including avoiding smoking, taking unprescribed painkillers and dietary modifications that include avoiding foods that irritate the stomach such as pineapples, avoiding alcohol and any form of fasting.

Usually, even without eating food, stomach acid is continuously produced and eating mixes with the acid helping to prevent direct exposure of this acid to the ulcer wounds.

Fasting exposes the peptic ulcer wounds to stomach acid that eats into the wounds hence increasing pain and the likelihood of complications including bleeding and perforation. Even for those not suffering from ulcers or gout, water fasting beyond three days is not advised unless one’s doctor okays it.
Send your questions to: features@ug.nationmedia.com

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