Treatment of HIV in Pregnancy

Treatment of HIV in Pregnancy

HIV and Pregnancy

Human immunodeficiency virus (HIV) is the virus that causes AIDS. While it can be a scary diagnosis, there are treatments that will help you live a full life. With current treatments, being HIV positive doesn’t even mean that you can’t have children if you want to. However, HIV can be passed along to your baby during pregnancy, birth, or breast-feeding. By taking proper precautions, you can do your best to ensure that your child doesn’t get HIV.

Trying to Get Pregnant When You Have HIV

If you have HIV and want to become pregnant, talk with your HIV specialist and obstetrician first. Find out if your medication is safe during pregnancy or if you should switch before you try to have a child. For example, don’t take efavirenz if you plan to get pregnant. You’ll also likely be told to get as healthy as possible before you get pregnant.

How HIV Is Treated in Pregnancy

If you have HIV and just learned you’re pregnant, schedule an appointment with your HIV specialist and obstetrician to discuss your treatment plan. You’ll get blood tests to see how much HIV you have in your blood (viral load) and your CD4 count. This is a measurement of your immune system’s strength. This blood work and HIV monitoring should and will continue during your pregnancy. You’ll also get ultrasounds to ensure that the baby is growing properly.

Taking medications may improve the mother’s health and can help lower the risk of giving the baby HIV. Taking a combination of HIV drugs has been found to help better prevent giving HIV to newborns than just taking AZT, or zidovudine. Zidovudine is among those drugs usually given when possible. It’s been found to help lower the risk of HIV transmission to the baby.

Some drugs can’t be used during pregnancy and some will require a new dosage. Factors that are considered for changing your treatment include:

  • your weight
  • how far along your pregnancy is
  • your risk of the HIV progressing
  • how strong your immune system is (your CD4 count)

Certain medications have restrictions during pregnancy, such as nevirapine and efavirenz. Nevirapine is usually not started in women with a certain CD4 count. Efavirenz shouldn’t be started in early pregnancy. If you took that medication and subsequently conceived, it should be fine to continue it. Always check with your doctor if you have any questions about your medications.

Regardless of what medication you’re taking, be sure to take it as prescribed. That will help reduce the risk of transmission to the baby and your own drug resistance.

If you’re in your first trimester and have discovered you have HIV, your doctor will decide if you should start treatment right away or delay it. Factors that will be considered are if you have morning sickness, since it may make it difficult for you to start HIV drugs, and whether the treatment will help prevent HIV in your baby.

When You Give Birth

You and your doctor will discuss the safest way for you to give birth. It will either be a vaginal birth or a cesarean section. Your delivery method will depend on the level of HIV (your viral load) in your blood during pregnancy. If the risk of transmission is low, vaginal delivery is recommended. A C-section will be suggested if you have high levels of HIV in your blood or you’re concerned about exposing the baby to vaginal fluids or blood. If you have a high amount of HIV in your blood you may get a drug called azidothmidine (AZT) intravenously during labor to help reduce the risk of HIV transmission.

Talk to your doctor about your treatment regimen during labor. If you’re taking combination HIV medications, you’ll likely continue to take them on schedule before your delivery. This will help protect you and the baby.

Once Your Baby is Born

Be sure that your baby is tested for HIV right after birth.  However, you may not know for certain if your baby has HIV until they are 3 months old, according to the U.S. Department of Health and Human Services.

Even if you don’t know your results, ask the specialist if your baby should take anti-HIV medications. Studies have shown than giving a newborn two or three anti-HIV medications (as opposed to one medication) halves their risk of HIV, according to the Office on Women’s Health. Be sure to ask if your baby needs any other medications to prevent infections until an HIV diagnosis is confirmed.

If you took medication during your pregnancy and you find out that your baby doesn’t have HIV, your baby should still receive long-term follow-up care. Talk with your doctor about how long the child’s health should be monitored.

Breast-feeding can pass HIV onto a baby. Even if you’re taking HIV medications, it can be transmitted through breast milk. It’s recommended that you not breast-feed if you have HIV.

After the baby is delivered, talk to your HIV specialist about adjusting any medications and doses.

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