HIV and Pregnancy

Women who are infected with HIV are at risk of passing the infection on to their babies. Approximately 25% of all babies born to HIV-positive pregnant women are infected with the virus. Here is what you need to know about HIV and pregnancy.

What is HIV?
The human immunodeficiency virus, or HIV, is a sexually transmitted disease (STD). It is a viral infection that is transmitted through unprotected vaginal or anal sex with someone who is infected with the virus. It is also spread through sharing needles (most commonly those used for illicit drugs but also through needles used for tattooing and piercing), breast milk and contact with an infected persons blood.

Know how testing for sexually transmitted diseases is done and the symptoms associated for an early diagnose and treatment as well.

HIV Symptoms
Unlike many other STDs that have distinct signs and symptoms, many people who are infected with HIV fail to realize that they are due to a lack of symptoms. It has been estimated that as many as one in three people are infected with HIV although they may not be aware of it.

If HIV symptoms do occur, they may be easily mistaken for the flu. Early symptoms of HIV tend to include muscles aches, low fever, headaches, fatigue, and swollen glands. These symptoms can last for a week to a month. Afterwards, the virus can lie dormant in your system for many years.

HIV and Pregnancy
There are a number of steps you can take to prevent transmitting an HIV infection to your child when you are pregnant. Using antiviral drugs, having a cesarean section and not breastfeeding your child can lower your infants risk of infection to less than 2%.

HIV Medications During Pregnancy
If you are currently taking HIV medications to help manage your infection, you should discuss with your doctor whether you need to change your drug regime for your pregnancy. Women who are not currently taking any medication for HIV may also want to discuss with their health care provider the risks and benefits of starting treatment to help protect both yourself and your developing baby. Certain HIV medications should not be used during pregnancy as they have been shown to cause birth defects. These include:

• efavirenz (Sustiva)
• stavudine (Zerit)
• amprenavir (Agenerase) in oral form
• hydroxyurea

Other medications have not been properly assessed for safety during pregnancy. Speak with your health care provider about the pros and cons of any HIV medication.

One type of HIV treatment that is strongly recommended for all women is ZDV (also known as zidovudine or AZT). Using ZDV therapy during pregnancy has been shown to be almost 70% effective in eliminating the risk of HIV transmission between mother and child. This is a three-part treatment that should be started between the 14th and 34th week of pregnancy.

During pregnancy, women are advised to take either 100mg of ZDV five times a day, 200mg three times a day or 300mg two times a day. ZDV should be administered intravenously throughout your labor and delivery. If you are having a c-section, then treatment should begin three hours prior to the surgery. After birth, your child will also need regular liquid doses of ZDV every six hours for the first six weeks after birth.

Delivery and Birth
HIV-positive women may have a c-section done at 38 weeks or have a vaginal birth. Which you have will depend on your circumstances.

A cesarean is recommended for those women whose viral load at 36 weeks is unknown or more than 1000copies/mL; have not taken any antiviral drugs or only taken ZDV during their pregnancy; or who have not received any prenatal care prior to 36 weeks gestation. While a c-section does lower your risk of mother-to-child transmission, it is considered to be major surgery and does have some associated risks.

A woman who is infected with HIV may consider having a vaginal birth if her viral load is less than 1000 copies/mL, is taking ZDV with or without other HIV medications and has been receiving prenatal care throughout her pregnancy. The risk of mother-to-child HIV transmission is higher with a vaginal birth, though. Additionally, it is a good idea to avoid using any birthing instruments that may puncture your newborns skin and minimize the mixing of your blood with your child's as much as possible.

New research has suggested that HIV transmission from mother to baby may actually occur as a result of small leaks in the placenta during labor contractions. These findings are consistent with the fact that women tend not to transmit the virus if they have a c-section before going into labor while women that have an emergency c-section, after they have started labor contractions, do transmit the virus. As a result, women infected with HIV may be encouraged to take antiretroviral drugs before starting labor.

HIV Testing
Shortly after your child's birth, she will be tested for the HIV virus. She will then be started on ZDV treatment. At about 6 weeks after birth, when her ZDV treatment is finished, she will be tested for HIV again. Unlike an adult HIV test, which measures the number of HIV antibodies in your system, your newborn will have her blood analyzed for the actual virus. This is because infants receive their antibodies from their mother. As a result, testing a newborn for HIV antibodies would always provide a positive result although the infant may not actually by infected with HIV.

Your baby should also have a complete blood count test done, which will measure her red and white blood cells, platelets, hematocrit and hemoglobin. An abnormal level of any of these blood components may indicate a problem. She should also be monitored for anemia as it is a common side effect of the six-week ZDV treatment.

After Birth
During the postpartum period, you may want to change your medication regimen or stop taking the antiviral medication altogether. Discuss the issue with your health care provider before you change or stop any of your medication. Because HIV can be transmitted through breast milk, new mothers are generally advised to feed their infant with formula instead.

Between four and six weeks after birth, your baby should begin to receive treatment for P. carinii/jiroveci pneumonia (PCP). PCP is a serious infection that causes your lungs to fill with fluid and is considered to be an AIDS-defining illness. If your baby develops PCP, she will be diagnosed with AIDS. Treatment for PCP can be discontinued once your baby's six-week HIV test shows her to be free of the virus. If she is HIV-positive, treatment for PCP as well as HIV/AIDS will need to be continued indefinitely.

Worried about HIV and your pregnancy? Visit our Pregnancy Complications forum to talk about it with other women.