HIV and Pregnancy

by Brian M. Williams

HIV and PregnancyThere are more than 1.2 million people in the United States estimated to be living with HIV/AIDS. What's more, 25 percent of them are undiagnosed and unaware of their HIV infection.

Approximately 25 percent of people living with HIV in the United States are women and most are of childbearing age. Every year, more than 6000 HIV-positive women in the United States give birth.1

HIV, the virus that causes AIDS, brings on symptoms that are mild at first or could be mistaken for the flu or a cold. Many HIV positive women don't realize they're infected.

Testing for HIV

Whether or not you suspect you're infected with HIV, the Center for Disease Control recommends that all pregnant women have an HIV test at their first prenatal visit.

If you don't choose to test early in your pregnancy, your healthcare provider might ask you if you'd like to be tested in the third trimester using a rapid HIV test. If you test positive, your baby will have the benefit of medications to prevent transmission during delivery.

Benefits of HIV Testing

A mother who knows that she's HIV-positive early in her pregnancy, has more time to work with her healthcare provider to figure out how to protect her health and prevent transmitting HIV to her child.

If an infected woman isn't treated, the risk of transmitting HIV during pregnancy, birth, or postpartum to her baby is 25 percent. If HIV is diagnosed early on, medication can be given to lower the risk to 2 percent or less. The woman can also take steps to prevent passing HIV to her partner.

The HIV Antibody Test

A blood sample taken during your prenatal visit is tested for HIV antibodies. The test doesn't hurt you or your baby. You should get results back in a few days.

Planning Starts Before Pregnancy

Have you been diagnosed as HIV-positive? According to the Women Living Positive1 survey, about half of the HIV-positive women haven't discussed how their treatment options could affect their pregnancy until after they've already become pregnant.

Be proactive and talk to your HIV specialist about your choices. Discuss your goals early on in your treatment. This way you can work with your healthcare provider to avoid changes and modifications to the program after you become pregnant.

Dawn Averitt Bridge, a prominent HIV/AIDS advocate, was 19 years old when she was diagnosed with HIV in 1988. She was given six month to live. Now she's the mom of two daughters, who are HIV negative. HIV-positive women can have children with a significantly reduced risk of mother-to-child transmission of HIV. It's possible through aggressive prenatal care, and good access to treatment.

HIV-Positive and Pregnant: Your Care Plan

Your prenatal plan will address the medical, psychological, social and practical challenges of pregnancy with HIV. Your pregnancy will most likely be coordinated between a healthcare provider and HIV specialist.

If You're Presently on Anti-HIV Medications

Providers suggest that you continue taking your anti-HIV medications until you talk to your own healthcare provider. Contact them right away if you are taking Sustiva (or Atripla, an anti-HIV medication that contains Sustiva).

During the first trimester of pregnancy, Sustiva alone or in Atripla, may cause birth defects that develop during the first few months of pregnancy. Your healthcare provider will discuss safe alternatives for these medications. After the first trimester, Sustiva or Atripla can be used safely.

Anti-HIV Medication During Pregnancy

Taking anti-HIV medications during pregnancy reduces the amount of HIV in an infected mother’s body. Having less HIV in the body reduces the risk of mother-to-child transmission of HIV.

Some anti-HIV medications pass through the placenta and help protect the baby from HIV infection. This is especially important during delivery when the baby may be exposed to HIV in the mother’s genital fluids or blood.

Anti-HIV medications are used at the following times to reduce the risk of mother-to-child transmission of HIV:

1. During pregnancy women infected with HIV usually receive a combination of at least three different anti-HIV medications.
2. During labor and delivery pregnant women infected with HIV receive intravenous AZT.
3. After birth, babies born to women infected with HIV receive liquid AZT for 6 weeks.2

Giving Birth

Procedures like intentionally rupturing the amniotic sac to induce labor and episiotomy expose your baby to your blood or fluids. Since the chance of transmission increases if your baby is exposed, your doctor will probably avoid them.

If you haven't received any drug treatments before labor, medication could be offered during labor. Studies suggest that these treatments, even for short durations, may help reduce the risk to the baby. Possible drug regiments include a combination of ZDV and another drug called 3TC or Nevirapine.

Your healthcare provider might suggest a cesarean section, especially if you haven't received medication during pregnancy. If performed before labor or the rupture of membranes, a c-section might significantly reduce the risk of transmission of HIV.

Your Baby's First Weeks

Within six to 12 hours after delivery, babies born to women infected with HIV receive an anti-HIV medication called AZT. AZT helps prevent mother-to-child transmission of HIV. Your baby will continue to receive AZT for 6 weeks.

It's recommended that your baby be tested for HIV at 14 to 21 days, at 1 to 2 months, and again at 4 to 6 months. The HIV tests look directly for the presence of HIV in the blood.

To be diagnosed with HIV, a baby must have positive results from two virological HIV tests. For the baby not to be infected with HIV, the child must have two negative virological HIV tests. The first will be done at 1 month of age or older, and the second at least one month later.

The HIV virus is passed through direct contact with blood and other body fluids. It's not transmitted through hugs. Go ahead and snuggle and enjoy your tiny bundle!

Should You Breastfeed Your Baby with HIV?

It depends on your situation. The CDC recommends that if breast milk substitutes used with clean water, and affordable healthcare is available, you feed your baby formula.

In some countries, including the United Kingdom and United States, HIV positive mothers who choose to breastfeed could be charged with child endangerment if they persist. You always want to do do what will be safest for your baby, so learn about your options.

HIV-positive women who breastfeed could reduce the risk of transmission by:

1. Breastfeeding exclusively the first six months. It's thought that other foods or fluids added to the baby's diet might cause gut infections that could increase the risk of HIV transmission.4
2. Shortening the duration of breastfeeding. Studies suggest that HIV transmission increases dramatically after 12 months of breastfeeding. Experts recommend a transition from exclusive breastfeeding to formula at about six months.
3. Preventing and promptly treating your baby's oral lesions and your breast problems. If your baby has an oral lesions or you have cracked nipples or mastitis, the risk of transmission is higher.
4. Taking anti-HIV drugs. Several studies are underway to determine the effectiveness of medications while breastfeeding and if they can reduce transmission.

Are you affected by HIV or AIDS? How do you cope? Share your story!


SOURCES:
1. The Women Living Positive Survey (2007, October). Accessed (March 7, 2012)
2. HIV and Pregnancy (2012)
3. Townsend CL et al. (2009) "Antiretroviral therapy and congenital abnormalities in infants born to HIV-infected women in the UK and Ireland, 1990-2007." AIDS 23.
4. Linkages Project (2004) "Breastfeeding and HIV/AIDS Frequently Asked Questions." Accessed (March 7, 2012)

Copyright © Pregnancy.org.