Children’s Day was on the 1st of June, this was a day when Roman Polikarpov, a wonderful pediatrician joined our platform WOMAN.PLUS aiming to help women with HIV.
My name is Roman Polikarpov. I graduated from Rostov State Medical University. My professional activity began at the Rostov Center for AIDS Prevention and Control. For more than six years I have been working as a pediatrician at the Regional Children’s Clinical Hospital. For
the last 2 years I worked as the Chief Physician Deputy for prevention at Children’s Hospital N 1 in Rostov-on-Don. Among other things my professional interests have always been around children’s infectious diseases, including HIV infection and vaccination. In my clinical work I
have to deal a lot with children’s emergencies. Through administrative work in pediatric medicine I have got experience of dealing with the most unusual situations in the organization of care for young patients. I dream of the world without children’s tears, believe in what is scientifically proven and effective, value love, friendship and help.
1. Roman, could you tell us about the beginning of your professional activity, your work in the SC?
Immediately after graduation, I entered residency, studied at the Department of Pediatric Infectious Diseases of Rostov State Medical University, and in 2013 I went to work at the AIDS Center. Although I worked there for a short time, I still supervise some patients.
2. Does the approach to preventing HIV transmission during pregnancy and in newborn babies differ today?
Since 2015, the testing intervals have slightly changed. An important change is that women are advised today not to interrupt their antiretroviral therapy after pregnancy. Previously, this was a common practice among mothers with good CD4 counts and low viral load, which created risks for subsequent HIV treatment. It is pleasant that today more and more women with HIV in Russia have the opportunity to choose their own maternity hospitals and to receive at least part of breast-milk substitutes for their children during their first year of life free of charge.
3. Many mothers with HIV worry about the health of their future children, let’s talk again about the prevention of perinatal transmission.
First of all I would like to say that such worries are absolutely normal. It is important to follow the recommendations of the attending physician, the infectious disease specialist as much as possible. Approaches to the prevention of vertical transmission of HIV in modern medical practice are fully developed, one just needs to follow them. Pregnancy should be planned and antiviral therapy should be started well in advance. My observations allow me to speak about complete elimination of vertical transmission of HIV in case of timely diagnosis, early start of treatment, planned pregnancy after reducing the viral load to an undetectable level and strict adherence to therapy! The second important thing to consider is the screening for other diseases. Pre-pregnancy preparation allows to assess various risks, not only those related to HIV, and to reduce them to zero.
4. “Contact children” are children who are born to mothers with HIV. How soon, in most cases, is the child taken off the register?
The main reason for the care at the AIDS Center to be stopped is the elimination (or disappearance) of maternal antibodies to HIV in the child’s blood test. But usually a repeated negative PCR test at six months of age makes it clear to the doctors that the child is healthy. But since antibodies to HIV persist on average until the baby is a year and a half old, we watch him or her until this age. In practice, there are cases where antibodies persist even longer up to two or two and a half years. Parents always start to worry a lot. It is important to understand that certain factors influence the elimination of antibodies, but doctors have to be sure that the child is healthy. We can discontinue follow-up even earlier if all PCR and antibody tests are negative and there are no signs of immunodeficiency.
5. In some countries, the clinical guidelines allow breastfeeding (with an undetectable viral load), but in Russian guidelines it is not. Why is it?
Yes, clinical guidelines vary from country to country. Breastfeeding is usually allowed in countries where there is a risk of starvation of the baby, but this increases the possibility of transmission to the baby through breast milk. In our country, starvation is usually not as much of an issue, so domestic clinical guidelines are designed to reduce the risk of mother-to-child transmission of HIV as much as possible. As far as I know, studies on the risks of HIV transmission through breastfeeding, even with ART and an undetectable viral load, have not yet been conclusive on the complete safety of this approach.
6. Many moms worry that artificial nutrition will make their baby sick and a child won’t get all the right elements, is this true?
Today, the market for baby food has well-adapted artificial formula, as close in composition as possible to mother’s milk. With these mixes, the child will get almost all the important elements and will not get sick a lot. Of course, breastfeeding also has a psycho-emotional function. But the priority is the child’s health in terms of eliminating the risks of HIV transmission.
7. Does child prophylaxis differ depending on how committed the mother has been to therapy?
The commitment to therapy determines the number of drugs prescribed to the child for prophylaxis and the timing of their administration. If a woman started taking therapy late during pregnancy or took it irregularly, the delivery tactic will change. The child will take a more comprehensive prevention therapy for a longer period of time. Planning, preparation for pregnancy, and strict medication “lightens” the drug regimen for the newborn and shortens the duration of the regimen.
8. Why did you agree to help womanplus.info?
When asked to help the question “should I or shouldn’t I?” or “why me?” doesn’t exist for me I’m glad that I can be useful with my knowledge. How can one refuse an opportunity to make the world a little better?
