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HIV Treatment In Pregnancy
Frequently asked questions about pregnancy and HIVWelcome to the Motherisk Web site about HIV and HIV treatment. This site is for women and couples who are thinking of having a baby, are already pregnant, or have had their babies - and the professionals who work with them. Remember to return to the drop down menu under HIV & HIV Treatment in the left hand frame for other topics.
I am pregnant or thinking about having a baby. Should I be tested for HIV?
If you are thinking of having a child or you are already pregnant, it is important that you get tested for HIV. There are many pregnant women who are HIV positive and do not know about it.
If you are HIV positive and you are aware of this infection, then there are very good prevention strategies available to decrease the risk of your child becoming infected. Without any kind of prevention strategy, the risk of mother-to-child transmission is about 25%. However, if prevention strategies begin in sufficient time, this risk can be reduced to 1%.
Learn about HIV testing during pregnancy in Canada at Caring for Kids - Testing for HIV
I am/we are HIV positive. Is it possible to conceive safely?
There is information available to help infected partners or couples take protective measures to help reduce the risk of transmitting HIV infection to their partners and babies. The counsellors and health professionals at our toll-free Motherisk HIV Healthline can provide you with information and written resources to minimize the risk to non-infected partners.
The reproductive options of HIV-infected couples and more specific information for couples when the male partner is infected and the woman is not, can be found at:
The Body - Reproductive Options
HIV In Site
I am/my female partner is HIV positive. Is pregnancy harmful to the health of women with HIV infection?
Studies indicate that pregnancy does not harm the health of women with HIV infection or increase the chance of women developing HIV related illnesses. Additional information about planning for a healthy pregnancy for women with HIV infection can be found at Project Inform
I am HIV positive and pregnant. Will my baby be infected as well?
Most babies born to HIV-positive mothers will not get HIV. But some will. A baby can get HIV from its mother during pregnancy (before birth), during delivery (the most common way babies get infected), and through breast feeding.
There is approximately a one-in-four chance of mother-to-child transmission of HIV infection without any treatment. But, treatments and interventions exist that have been shown to significantly reduce the risk of infection to babies. If you would like to learn more about mother-to-baby HIV infection, register with MEDSCAPE and use their search engine to find articles on "Perinatal HIV."
During pregnancy and delivery, you can take antiretrovial drugs to reduce the risk of transmission. If you take a combination of antiretoviral drugs during pregnancy and delivery, and your newborn receives one of these drugs, the chance of transmission drops to about 1%.
Other strategies that can help to reduce the risk of infection include a shortened delivery time, and in some circumstances delivery by Cesarean section. Additional information about reducing the risk of HIV transmission to babies can be found at:
The Body - pregnancy and HIV
The Body - Antriretoviral Therapy
If I am HIV positive and pregnant, should I deliver the baby by cesarean section?
Whether you should deliver by Cesarean-section or vaginally depends on your HIV viral load level (how much of the virus is circulating in your blood) at the time of delivery.
If you are not taking any medication to lower your viral load or if you are just taking zidovudine, it is likely that your viral load will not be low enough to deliver vaginally without a significat risk of transmission of HIV to the baby. In this case, a Cesarean section would reduce the risk of transmission by half.
However, if you are taking a combination drug therapy to control your infection and the amount of virus circulating in your blood is undetectable, then there is no clear advantage to a Cesarean delivery compared to vaginal delivery. You should talk to your doctor, who can look at your particular situation, and provide appropriate advice concerning the mode of delivery for you.
If I take antiretroviral drugs during pregnancy, will that hurt my baby?
The use of antiretroviral drugs in prevention programs began around 1994, therefore, the number of women who have taken these drugs is still small and the babies born to these women are still young. It is too early to say for sure that there will be no problems. Until now, no major problems have been identified in children exposed to antiretroviral drugs.
If you have any further questions about taking HIV drugs during pregnancy, or want specific information about particular drugs or drug interactions you should call The Motherisk HIV Healthline 1-888-246-5840. You can visit CATIE and HIV Medication Guide
If I am HIV positive, can I breast feed my baby?
No. Breast milk is one way to pass on HIV to your baby. Your baby should receive infant formula as a safe alternative to breast milk. Studies have shown a 14% rate of HIV transmission when mothers with HIV breast feed their babies.
In Canada there are programs to provide free formula for babies of mothers with HIV. If you live in Ontario you should contact the Teresa Group at (416) 596-7703 or www.teresagroup.org to receive this service.
In other parts of Canada contact the Canadian AIDS Society (CAS) for information at (613)230-3580 or call the Motherisk HIV Healthline toll-free number at 1-888-246-5840. Additional information on HIV and breastfeeding can be found at The Body - HIV and Breast Feeding
Do babies with HIV infection look different?
When will I know whether my baby is HIV positive?
Three successive blood tests are performed which taken together indicate whether the virus has been passed on to your child:
- Within the first few days of the baby being born;
- At 1 month of age; and
- At 2 to 4 months of age
If all three of these tests are negative for HIV, then the baby does not have HIV infection. If any of the above tests are positive, then another test is done. If two of the tests are positive, then the baby is infected with HIV. Additional information about HIV testing of children can be found at Canadian Paediatric Society.
If I am HIV positive, will my baby need any extra medicine?
Yes. Your baby should take an antiretroviral drug called zidovudine in syrup form for six weeks after birth. Zidovudine will provide further protection against HIV infection.
At six weeks following completion of antiretroviral therapy babies should receive an antibiotic called trimethoprim/sulphamethoxazole (TMP/SMX) commonly known as Septra and manufactured by Glaxo Wellcome Inc. An alternative to Septra is an antibiotic called Bactrim, manufactured by Hoffmann-La Roche Limited.
These antibiotics are given to babies for six weeks (or until it is confirmed that the baby is not infected) to help prevent pneumonia that often occurs in babies with HIV infection. Visit the Canadian Paediatric Society for information about the care of HIV-exposed infants.
Should my baby get the same vaccines (needles or shots) as other babies?
Yes. Your baby should follow the same vaccine schedule as other babies. Visit the Canadian Pediatric Society on care of the HIV-exposed infant for further information.
Should I take my baby to an expert?
In order to ensure that you and your baby receive optimal services and information your doctor should check with a specialist in HIV and children. An HIV specialist is typically part of a team of health care workers that includes doctors, nurses, social workers, dieticians, pharmacists, physiotherapists and occupational therapists. Some of these people may be useful resources for you as well. A list of provincial centres that provide HIV care for children is included on this Web site.
Where can I find additional sources of information about pregnancy and HIV?
The following Web sites provide useful information and resources for women and couples to help in pregnancy and treatment decisions.
Caring for Kids
The Body - Women and HIV
Positive Women's Network
What should I know about nutrition?
Nutrition plays an important role in maintaining health, especially for people living with HIV infection. Visit FXBCenter and HIVATIS for information on nutrition and health.
How do people get HIV?
HIV is found in blood, semen (the fluid containing sperm), vaginal fluid, and breast milk. A person can become infected in one or more of the following ways:
- Sex (vaginal, anal, or oral) with a person who is infected with HIV.
- Sharing needles contaminated with HIV-infected blood.
- Receiving a transfusion of infected blood (extremely uncommon since 1985).
- Perinatal transmission that involves a baby becoming infected while in the mother's womb or during birth, if the mother has HIV.
- Mothers can pass HIV to their babies through breastmilk.
Further information about HIV transmission can be found at the FXB Center
Can HIV be prevented?
Since we know the ways that HIV is spread, we know how to keep people from getting infected. Contact with blood, semen or vaginal fluids should be AVOIDED and mothers with HIV should not breast feed their infants. Gloves should be warn when contact with blood is likely to occur. In the event of an accidental exposure to blood, immediate washing of the area with soap and water usually provides adequate protection unless the blood is able to enter the skin through an open wound. General basic prevention information can be found at the FXB Center - HIV Basics
Is there a place I can go to learn more about HIV terms?
Yes, the FXB Center includes a glossary that can be used to search out unfamiliar words or medical terms related to HIV infection.