HIV And Pregnancy
If I have HIV can I conceive a child who is HIV negative?
These days in the United States, many HIV-positive women give birth to children and virtually none of them are HIV infected. We can almost completely prevent transmission of HIV from infected mother to child.
What should I do if I have HIV and become pregnant?
If you are HIV positive and become pregnant, just as with any pregnant woman, you should seek medical care early on. It is particularly important if you are HIV positive because what needs to be done, if you are not on antiretroviral therapy for your HIV, is to go on antiretroviral therapy and suppress the HIV virus to undetectable which will mean that the child will not get infected with HIV in the womb or during the birth process. In fact, it is during the birth process while the DNA is in the birth canal that there is the highest risk for the foetus to acquire the HIV infection. So if the mother's HIV virus is completely under control and undetectable in her blood at the time of birth, there is little chance that the child will be infected with HIV at birth.
Will a pregnancy make my own health worse if I have HIV?
For some time, we worried that if an HIV-infected woman got pregnant, that it would make her HIV disease worse. It appears not to be the case, and HIV-positive women usually manage pregnancy quite well.
If I have HIV but do not need medication, should I take medication when I'm pregnant?
If an HIV positive woman is not on medication for HIV and gets pregnant, she should start it because the HIV virus should be suppressed in her for the sake of her child, to prevent HIV transmission. Even if a woman's HIV viral load is low and CD4 count is high, if she gets pregnant she should still go on antiretroviral therapy to suppress the viral load to undetectable so that the child will not become infected with HIV.
If I am currently on HIV medication, should I continue the medication if I am pregnant?
If an HIV positive woman is on medication and gets pregnant, she should probably just stay on the HIV medication she's on, but it depends a little bit what the drugs she's on are. If she's on Efavirenz or Sustiva she should change off it for another HIV medication, especially in the first trimester of pregnancy, and there are some nucleosides used to treat HIV, like d4T and ddI that shouldn't be used during pregnancy, or certainly not in combination, so it would be a good thing, if an HIV woman on therapy gets pregnant, to check with her HIV doctor very early on to see if she should stay on the same medication or if she should maybe change one of the HIV drugs out.
What are the risks of taking HIV medication during pregnancy?
There's very little risk from antiretroviral therapies in pregnancy but there have been some fetal abnormalities seen in monkeys with Efavirenz or Susteva.So people are worried about women getting pregnant on Susteva; probably it only really matters in the first 3 months so women of child bearing age shouldn't even be on that drug because the danger probably occurs before they realize they're pregnant in the very early phases of the pregnancy so women of child bearing potential who are having unprotected sex shouldn't really be on Efavirenz or Susteva. And the drugs d4T, zerotine, DDI, Videx which are not much used now in this country but when used together in pregnancy have caused a very severe illness which often leads to death called lactic acidosis we don't ever use those drugs together in combination now in this country but you know there might be the odd woman somewhere in the United States on that combination and it would not be a good thing if she was pregnant.
Will having a caesarean section reduce my baby's chances of contracting HIV?
Caesarean section does reduce the chances of a baby getting infected during the birth process and most HIV transmission from mother to child actually occurs during birth, not during pregnancy but during the actual process of birth. So, if you do a caesarean section and the child doesn't have to go through the birth canal then there's less chance of the child getting infected. However it's not necessary, in the United States at least, if any retroviral therapy has been given and the virus is undetectable in the mother, then the child will not get infected in the birth canal. Caesarean section is a major operation, and sets up possible problems for future pregnancies. Generally, we don't want to have to do a caesarean section and would not advise it, with the exception if a woman came with high viral load and not in labor or just commencing labor then the caesarean section may be appropriate to reduce the chances of that child's getting infected.
How can a baby become infected with HIV during the birth process?
There is a lot of blood in the birth canal, and we believe the child gets infected from the blood in secretions from the blood in vaginal secretions during the birth process. Even so, only a third of babies born to HIV positive mothers are infected, even if no antiretroviral therapy or no precautions are used. However that percentage is much higher, not surprisingly, if the mother has a very high HIV viral load and advanced disease. If the mother has a very low HIV viral load naturally, without treatment, then the percentage chance of the child getting infected with HIV would be much less.
How should I feed my baby if I have HIV?
An HIV-positive mother should preferably use formula feeding in the Western world to prevent any chance of mother-to-child transmission from breast milk. However, in resource-limited settings, that is not generally the advice. Because to feed a baby with formula food made up with an uncertain water supply, an unsafe water supply, would mean many more deaths from gastroenteritis in infants than would come about from breast transmission of HIV. So the recommendation in resource-limited settings, the third world, is that mothers do breastfeed their children. However, it's interesting that if mothers breastfeed and formula-feed, or give the baby food as well, that increases the chance of transmission. It doesn't decrease it. We believe the reason is because when babies get foreign food and foreign protein, there's inflammation set up in their bowel, which means it's more likely that any virus in the breast milk will infect them. So, if mothers who are HIV-positive are breastfeeding, they should exclusively breastfeed. The baby shouldn't receive anything other than their breast milk until they stop, and then they should receive only food and not any breast milk.
