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If you’re pregnant and HIV positive, you likely have many questions and concerns.

First off, you’re not alone. A 2018 study estimates that about 5,000 people living with HIV give birth every year.

And secondly, know this: Advanced anti-viral treatments now make living with HIV easier to manage and can also help protect you and your baby from this virus.

We want to empower you with the information you need — so let’s dive in.

HIV, or human immunodeficiency virus, is a virus that affects your immune system. It’s typically transmitted through sexual contact with someone who has it, or through blood and other bodily fluids.

You can have HIV without having any symptoms or knowing that you have it, which is why getting tested is important.

After you’re diagnosed with HIV and on regular treatment, you’ll still need to have regular checkups with your doctor to make sure the treatment is working well for you. Your doctor will give you tests that check:

  • Viral load. Every person with HIV has a different measure of the virus in their blood, known as their viral load. Knowing your HIV viral load is important because it shows how well your treatment is working. A low viral load also means that there is a lower risk of passing on HIV to someone else, including your baby.
  • CD4 Count. This test determines the number of CD4 cells that are in your blood. CD4 cells, also called T cells, are white blood cells that help your immune system fight infections. If you have HIV and are not treated, the virus may gulp up these cells, making it more challenging to fight infections and leading to other health issues. However, with the right treatment, you can manage HIV and increase your CD4 cell count.

If you’re HIV positive, it doesn’t mean that you have AIDS (acquired immunodeficiency syndrome). But without treatment, HIV may lead to AIDS. This happens when your CD4 cell count drops below 200.

It usually takes a while for HIV to develop into AIDS; the sooner you start treatment, the better for your health. There’s no known cure for HIV, but treatment can help keep you healthy and able to live a long life.

Medical studies show people living with HIV can have children just like any other parent. Being HIV positive doesn’t affect your fertility, and the many advances in HIV treatments make it safe for you to have a child.

In fact, everyone who becomes pregnant is required to be tested for HIV in the United States. Many who are HIV positive may not have symptoms for a while or may be unaware that they or their partner have HIV.

If you’re being treated for HIV, your baby will likely not get HIV. However, babies can become HIV positive in the womb (uterus) before they’re born or after birth.

There are three ways a baby can become HIV positive (perinatal transmission):

  • During pregnancy. While the baby is still in the womb, HIV can be transmitted through blood in the placenta.
  • During labor and delivery. If the baby comes in direct contact with your blood during delivery, or other liquids like the fluid inside the amniotic sac that surrounds the baby like a balloon, there’s higher risk of HIV transmission.
  • Through breastfeeding or chestfeeding. According to the global organization UNICEF, there’s up to a 10 to 20 percent chance of a baby getting HIV through nursing.

There are rare cases where you might have a higher chance for passing on HIV to your baby. These include having:

  • an illness that happens because you have HIV, such as tuberculosis
  • a low immune cell (CD4) count while having a high viral load
  • a sexually transmitted infection (STI) during pregnancy that’s not treated

If you have HIV, it doesn’t mean that your baby will get it. It’s possible to lower the risk of passing on HIV to your baby by almost 99 percent.

Some of the ways to lower the risk to your baby include:

  • taking medication
  • delivering your baby in a particular way
  • feeding safely

Medication

  • Your doctor will likely recommend that you take HIV medication during your pregnancy as well as during labor and delivery.
  • Medications that bring down viral load or the amount of HIV present in your blood help prevent it from being passed on to your baby.
  • Your newborn baby may also need to take HIV medication, just for a few weeks.

Although people are often told to decrease medications during pregnancy, if you’re HIV positive, staying on medication is safest. This helps to not only protect your health, but also to prevent transferring HIV to your baby via the placenta.

Delivery method

  • Your doctor may recommend that you have a cesarean (C-section) delivery to lower the risk that your baby will get HIV during birth.
  • You may have the option of a vaginal delivery if your HIV is well managed and your viral load isn’t detectable (meaning you have a very low amount in your body).

Feeding strategy

  • Although there’s a lower risk of transfer while breastfeeding or chestfeeding, your doctor may recommend not nursing your baby.
  • It’s also important to not pre-chew your baby’s food.

Not all HIV medication is recommended during pregnancy, as some may not be right for developing babies. Begin prenatal care as soon as you know you’re pregnant to make sure you’re getting the right treatment.

A doctor can choose the right drug for you and keep a close eye on your growing baby. The benefits of taking medication for HIV include lowering the chance of passing the virus to your little one.

HIV medication may add to some common side effects of pregnancy. However, the benefit of taking medication far outweighs these minor side effects. Common side effects of HIV drugs include:

  • nausea
  • diarrhea
  • muscle pain
  • headaches

More serious side effects related to the medication are rare. They include:

  • osteoporosis
  • anemia
  • liver damage

Nursing can offer health benefits for your baby. However, if you’re HIV positive, it may be best for your baby to be formula-fed. HIV can be passed on to your baby through your milk even if you have a very low viral count.

Even so, one medical review found that in some cases, the benefits of nursing may outweigh the risks if you’re able to maintain a low HIV viral count. The review looked at mothers passing HIV (perinatal transmission) to their babies and compared it to the benefits of breastfeeding.

However, in the United States there are affordable, balanced, and nutritious infant formulas as well as clean water. Speak with a doctor about the best formula for your baby and when to change it as they grow.

If you know you’re HIV positive and plan on becoming pregnant, there are ways to reduce the risk of transfer to your baby.

The most important thing is to speak with a healthcare professional right away and start treatment immediately, if you’re not already on it.