HIV Treatment in Pregnancy Health Article

During your first prenatal visit, it is important for your doctor to evaluate your health and your baby's health and to formulate an overall plan for prenatal care. As part of this comprehensive evaluation, your doctor will recommend that you undergo an HIV antibody blood test and should offer HIV counseling. (It is now the standard of care for all pregnant women to be tested for HIV). You should also be screened for a number of infectious conditions and vaccinated for influenza (flu) if your second or third trimester coincide with flu season, hepatitis A and B, depending on your risk factors, and tetanus/diphtheria if you are not up-to-date on that vaccination.

If you have HIV, it is important to talk to your doctor about the problems this infection can cause during pregnancy. The first prenatal visit is a good time to begin this dialogue. You and your doctor should discuss how HIV can affect your pregnancy and consider the best treatment plan for you and your baby. The information below will help familiarize you with these issues.

How Is HIV Infection Diagnosed?

There are several ways to diagnose an HIV infection. The diagnosis is usually made with an enzyme-linked immunosorbent assay (ELISA). This test is highly sensitive, inexpensive, and suited for screening large numbers of patients. If the ELISA is positive for the presence of HIV-specific antibodies, another study-a Western blot assay-is performed to confirm the diagnosis. This test also looks for antibodies to HIV, but is a more specific test. If a patient has a positive ELISA and Western blot, the likelihood of a false-positive result is less than one in 10,000. (A false-positive test is one that incorrectly diagnoses an infection when there isn't an infection present.)

Other tests in common use look specifically for the HIV virus, rather than antibodies against HIV. However, these tests are not used routinely for testing for HIV infection for the first time, since they can be falsely positive. Instead, HIV viral loads are used to monitor the effect of anti-HIV therapy once a patient is diagnosed with HIV infection.

In general, all pregnant women are routinely tested for HIV-1 infection during their first prenatal medical appointment. Testing for HIV-2 infection is usually performed simultaneously with testing for HIV-1 infection. Risk factors that may predispose a mother specifically to HIV-2 infection include if she has:

• had sexual contact or shared a needle with a person from an area where HIV-2 infection is common;
• traveled recently to an area where HIV-2 is endemic (primarily , , and );
• received a blood transfusion or non-sterile injection in such a locale; or
• clinical evidence of HIV infection but does not test positive for HIV-1.

If you test negative for HIV and have no obvious risk factors (for more information on risk factors, go to HIV in Pregnancy), you and your doctor will discuss ways for you to maintain a low-risk status. These include "safer sex" if not in a monogamous relationship and avoiding the use of intravenous drugs. If you test negative but have obvious risk factors (because of multiple sexual partners or intravenous drug use), you will be re-tested every two to three months.

What Are the Consequences of HIV Infection in Pregnancy?

In general, pregnancy does not hasten the progression of HIV infection. Women with HIV infection may be more likely than uninfected women to have complications in their pregnancy, although this questions is still under active study. Such complications include poor fetal growth, an increased frequency of maternal infection during labor and immediately after delivery, or preeclampsia (a condition of elevated blood pressure in the mother during pregnancy). Such complications can also put the baby more at risk for complications and possibly death.

Of particular concern is the baby's risk of developing HIV. More than 95% of all cases of HIV infection in children are due to transmission from a mother to her baby. Transmission may occur due to the virus crossing the placenta during pregnancy, but it is most likely to happen during delivery since the baby is exposed to the mother's infected blood, placenta, and genital tract secretions. Transmission also can occur after delivery as a result of breast-feeding. In the absence of any form of treatment for the mother or baby, the overall risk of transmission is 20 to 30%.

How Should Pregnant Women with HIV Infection Be Treated?

At your first prenatal appointment, you are offered screening for HIV infection. You are counseled about the risk of transmitting the infection to your baby if you are HIV positive. In addition, your doctor helps you get in touch with support personnel, such as social workers, nutritionists, and psychologists, to help you manage your HIV infection during pregnancy or manage a new diagnosis of HIV infection.

During your early prenatal appointments, you undergo screening tests for:

• other sexually transmitted diseases, such as gonorrhea, chlamydia, herpes, hepatitis B, and syphilis;
• cytomegalovirus and toxoplasmosis if you have advanced AIDS, since these infections may harm your baby (fortunately, they respond well to antimicrobial treatment);
• TB (tuberculosis);
• cervical dysplasia, which can be screened for with a Papanicolaou (Pap) smear; and
• CD4 count and viral load test (called HIV RNA-PCR). These tests assess both the state of your immune system and the progression of the disease (the degree to which the disease is advancing). CD4 lymphocytes are white blood cells that HIV attacks; a CD4 count measures the strength of your immune defenses. The HIV viral load helps your doctor decide on the response to medication, once anti-HIV treatment is prescribed

Go to Treatment of HIV in Pregnancy.