Medical Negligence
Doctors say that while there is a chance that the child is born without being infected, doctors will have to take extreme care and precautions.
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For the doctors and the health officials involved in the mitigation of risk from the negligent exposure of HIV positive blood to a pregnant mother at a government hospital in Tamil Nadu, one of the most important tasks now is to ensure that the child is born safely and without the infection. Experts TNM spoke to say that the child is likely to be born without the infection, but the doctors will have to take extreme care and several precautions to ensure that happens. 

“The transmission of HIV from a positive mother to an unborn child depends on the ‘viral load’,” explains Dr Amrose Pradeep, Chief Medical Officer (CMO) at YR Gaitonde Centre for AIDS Research and Education (YRGCare Hospital) in Chennai. “The highest risk of transmission occurs early on in the acute phase of exposure, because that is when there is a high viral load present.”

Viral load is a unit of measurement used by medical professionals to determine the number of viral matter (in this case the concentration of the HIV virus) in an individual’s bloodstream. During the initial period following exposure to the virus – which it is now for the mother, a person is said to have a high viral load. Thus, it would seem that the chance of transmission of the virus to the baby much larger. However, the presence of a healthy placenta shields the child against the virus.

“The virus cannot cross a normal, healthy placenta, and as a result the child will not be affected by the virus at this point,” he says, but warns, “A loss of structural integrity of the placenta can result in the virus being transmitted to the baby.”

Placental complications are common during the third trimester of pregnancy. It is at this juncture, if a mother is known to be HIV positive, that extra caution must be taken to ensure that the child is safe. The mother must be started on antiretroviral (ART) medications which will help decrease the viral load and will prevent the onset of Acquired Immunodeficiency Syndrome (AIDS).

“As far as I know, the mother has been started on the ART therapy and that is the first step. This will ensure that there is less chance of it being passed on to the child at the time of birth,” adds Dr Pradeep.

The second instance when the infection can be passed on from the mother to the child is during delivery. Since the child passes through the birth canal and is exposed to the mother’s blood and secretions, all of which contain the virus, there is a very high chance the child will be infected. To avoid this, doctors recommend that a C-section delivery is done, to reduce contact with the same fluids.

“After delivery, the child has to be given preventive care as well. For 6 weeks, that is 42 days, a combination of medications must be given,” said the doctor.

Speaking to media on Wednesday, Dr Radhakrishnan, Tamil Nadu Health Secretary, said that the mother and child would be given the necessary treatment and care to ensure that they are healthy. He added that the child would be started on prophylactic (preventive) medicines once born. “Nevirapine syrup will be given for about 6 to 12 weeks along with other medications to ensure that the child is not affected,” he said.  Doctors at YRGCare, recommend that nevirapine be given along with another ART medication known as zidovidine.

The case pertains to a 23-year-old pregnant woman who was given a blood transfusion at a government hospital in Sattur of Tamil Nadu’s Virudhunagar district. In an effort to improve her anaemic state, doctors recommended that she be transfused with a unit of blood. Days later, it came to light that the blood which she had been transfused with was HIV positive, and in an extreme lapse of processes and possible criminal negligence, it had not been detected by technicians responsible for screening of the blood. The three technicians responsible for the negligence have since been terminated.

Officials from the health department have stated that the cost for treatment would be borne entirely by the government. The mother is currently undergoing treatment and is being monitored by a team of doctors at Madurai’s Rajaji Government Hospital.