#safe
 | |  | |  | |  | |  | |  |
- Background and general questions
considering pregnancy or during your pregnancy.
The information will be useful at all stages – before, during and after pregnancy. It should help
whether you are already on treatment or not. It includes information for your own health and for
the health of your baby.
- Can HIV-positive women become mothers?
- How is HIV transmitted to a baby?
- Are pregnant women automatically offered HIV testing?
- How do HIV drugs protect the baby?
- Is it really safe to take HIV medicines during pregnancy?
- Will being pregnant make my HIV worse?
- If you have just been diagnosed with HIV
Can HIV-positive women become mothers?
Yes, with HIV treatment. Women around the world have safely used antiretroviral drugs in
pregnancy now for over 10 years.
Currently this usually involves taking at least 3 anti-HIV drugs, a strategy called combination therapy
or HAART (Highly Active Antiretroviral Therapy). These treatments have completely changed the
lives of people with HIV in every country where they are used.
Treatment has had an enormous effect on the health of HIV-positive mothers and their children. It
has encouraged many women to think about having children (or having children again).
Yes, with HIV treatment. Women around the world have safely used antiretroviral drugs in
pregnancy now for over 10 years.
Currently this usually involves taking at least 3 anti-HIV drugs, a strategy called combination therapy
or HAART (Highly Active Antiretroviral Therapy). These treatments have completely changed the
lives of people with HIV in every country where they are used.
Treatment has had an enormous effect on the health of HIV-positive mothers and their children. It
has encouraged many women to think about having children (or having children again).
| Regardless of pregnancy, women should receive optimal treatment for their HIV status. |
Your HIV treatment will protect your baby
The benefits of treatment are not just to your own health. Treating your own HIV will reduce
the risk of your baby becoming HIV-positive to almost zero.
Without treatment, about 25% of babies born to HIV-positive women will be born HIV-positive. One in
four is not good odds, though, especially because modern HIV treatment can almost completely prevent
transmission.
How is HIV transmitted to a baby?
The exact way that transmission from mother to baby happens is still unknown. The majority of
transmissions occur near the time of, or during, labour and delivery (when the baby is being born). It
can also occur through breastfeeding.
Certain risk factors seem to make transmission much more likely. The strongest of these is the extent of
the mother's viral load.
The benefits of treatment are not just to your own health. Treating your own HIV will reduce
the risk of your baby becoming HIV-positive to almost zero.
Without treatment, about 25% of babies born to HIV-positive women will be born HIV-positive. One in
four is not good odds, though, especially because modern HIV treatment can almost completely prevent
transmission.
How is HIV transmitted to a baby?
The exact way that transmission from mother to baby happens is still unknown. The majority of
transmissions occur near the time of, or during, labour and delivery (when the baby is being born). It
can also occur through breastfeeding.
Certain risk factors seem to make transmission much more likely. The strongest of these is the extent of
the mother's viral load.
As with anyone with HIV, an important goal of treatment is to reach an undetectable viral load. This is
particularly important at the time of delivery. The time between when your waters break and the actual delivery is
also a risk factor for transmission. This period is called 'duration of ruptured membranes'.
Other risk factors include premature birth and lack of prenatal HIV care. Practically all risk factors point to one
thing: looking after mothers health.
Some key points to remember:
Are pregnant women automatically offered HIV testing?
Healthcare providers have been required to offer and recommend that all pregnant women have an
HIV test in the UK since 1999. This is now part of routine prenatal care.
Routine testing is now recommended in many parts of the world.
It is important for a woman to take an HIV test when she is pregnant. Her ability to look after her own treatment,
health and well-being is improved when she knows if she has HIV or not. This knowledge also means that she is
aware of how she can protect her baby from HIV, if she tests positive.
How do HIV drugs protect the baby?
particularly important at the time of delivery. The time between when your waters break and the actual delivery is
also a risk factor for transmission. This period is called 'duration of ruptured membranes'.
Other risk factors include premature birth and lack of prenatal HIV care. Practically all risk factors point to one
thing: looking after mothers health.
Some key points to remember:
- The mother's health directly relates to the HIV status of the baby.
- Whether the baby's father is HIV-positive will not affect whether the baby is born HIV-positive.
- The HIV status of your new baby does not relate to the status of your other children.
Are pregnant women automatically offered HIV testing?
Healthcare providers have been required to offer and recommend that all pregnant women have an
HIV test in the UK since 1999. This is now part of routine prenatal care.
Routine testing is now recommended in many parts of the world.
It is important for a woman to take an HIV test when she is pregnant. Her ability to look after her own treatment,
health and well-being is improved when she knows if she has HIV or not. This knowledge also means that she is
aware of how she can protect her baby from HIV, if she tests positive.
How do HIV drugs protect the baby?
By reducing the risk that HIV will be transmitted to the baby.
Using a combination of 3 or more ARV drugs gives a transmission rate of less than 1%.
Reducing the risk of a baby becoming HIV-positive was an early benefit of ARVs.
From 1994, this strategy was recommended for all HIV-positive pregnant women in Western Europe and North
America. But even further advances have been made over the last few years.
AZT is still the only drug licensed for use in pregnancy. There is also a lot of experience of using it. Many
doctors still prefer to include it in a woman's combination if she is pregnant.
But, if you have resistance to AZT, you should not use this drug.
Other reasons some women do not use AZT might be that they find the drug's side effects difficult to manage or that
they are already on an effective, stable combination that does not contain AZT.
In these cases, it may be OK to use a combination without AZT. Transmission rates of mothers using combinations
without AZT are similar to those that contain AZT. A general rule of thumb is 'What's best for mum is best for baby'.
It is important to remember that using combination therapy for pregnant women is still relatively new. Many aspects of
its use are unproven. You will need to discuss the benefits and risks of treatment with your healthcare team.
Is it really safe to take HIV medicines during pregnancy?
Broadly speaking, yes.
In many cases, pregnant women are advised to avoid taking any medications. However, this is not the case when
considering the use of HIV treatment during pregnancy. This difference can seem confusing.
No one can tell you that it is completely safe to use HIV drugs while you are pregnant.
Some HIV medicines should not be used during pregnancy.
At the same time, many thousands of women have taken therapy during pregnancy without any complications to their
baby. This has resulted in many HIV-negative births.
During your prenatal discussions, you and your doctor will weigh up the benefits and risks of using treatment to you
and your baby.
Will being pregnant make my HIV worse?
Pregnancy and opportunistic infections
Pregnancy does not make a woman's own health get any worse in terms of HIV. It will not make HIV
progress any faster.
Being pregnant may cause a temporary drop in your CD4 count. This drop is usually about 50 cells/mm3, but it can
vary a lot. Your CD4 count will generally return to your pre-pregnancy level soon after the baby is born.
The drop should be a concern if your CD4 falls below 200 cells/mm3.
Below this level, you are at a higher risk of opportunistic infections (OIs). These infections could affect both you
and the baby, and you will need to be treated for them immediately if they occur.
In general, pregnant women need the same treatment to prevent OIs as people who are not pregnant.
Sometimes if you start taking treatment in pregnancy your CD4 count many not increase very much, even though
your viral load goes down. If this happens don't worry, your CD4 count will catch up after the baby is born.
HIV does not affect the course of pregnancy in women who are receiving treatment. The virus also does
not affect the health of the baby during pregnancy, unless the mother develops an OI.
If you have just been diagnosed with HIV…
Using a combination of 3 or more ARV drugs gives a transmission rate of less than 1%.
Reducing the risk of a baby becoming HIV-positive was an early benefit of ARVs.
- PACTG 076 (a famous joint American and French study) was the first research to show that using the drug AZT
could protect the baby from HIV. - Mothers took AZT before and during labour.
- The baby received AZT for six weeks after birth.
- This reduced the risk of the baby becoming HIV-positive from 25% to 8%
From 1994, this strategy was recommended for all HIV-positive pregnant women in Western Europe and North
America. But even further advances have been made over the last few years.
AZT is still the only drug licensed for use in pregnancy. There is also a lot of experience of using it. Many
doctors still prefer to include it in a woman's combination if she is pregnant.
But, if you have resistance to AZT, you should not use this drug.
Other reasons some women do not use AZT might be that they find the drug's side effects difficult to manage or that
they are already on an effective, stable combination that does not contain AZT.
In these cases, it may be OK to use a combination without AZT. Transmission rates of mothers using combinations
without AZT are similar to those that contain AZT. A general rule of thumb is 'What's best for mum is best for baby'.
It is important to remember that using combination therapy for pregnant women is still relatively new. Many aspects of
its use are unproven. You will need to discuss the benefits and risks of treatment with your healthcare team.
Is it really safe to take HIV medicines during pregnancy?
Broadly speaking, yes.
In many cases, pregnant women are advised to avoid taking any medications. However, this is not the case when
considering the use of HIV treatment during pregnancy. This difference can seem confusing.
No one can tell you that it is completely safe to use HIV drugs while you are pregnant.
Some HIV medicines should not be used during pregnancy.
At the same time, many thousands of women have taken therapy during pregnancy without any complications to their
baby. This has resulted in many HIV-negative births.
During your prenatal discussions, you and your doctor will weigh up the benefits and risks of using treatment to you
and your baby.
Will being pregnant make my HIV worse?
Pregnancy and opportunistic infections
Pregnancy does not make a woman's own health get any worse in terms of HIV. It will not make HIV
progress any faster.
Being pregnant may cause a temporary drop in your CD4 count. This drop is usually about 50 cells/mm3, but it can
vary a lot. Your CD4 count will generally return to your pre-pregnancy level soon after the baby is born.
The drop should be a concern if your CD4 falls below 200 cells/mm3.
Below this level, you are at a higher risk of opportunistic infections (OIs). These infections could affect both you
and the baby, and you will need to be treated for them immediately if they occur.
In general, pregnant women need the same treatment to prevent OIs as people who are not pregnant.
Sometimes if you start taking treatment in pregnancy your CD4 count many not increase very much, even though
your viral load goes down. If this happens don't worry, your CD4 count will catch up after the baby is born.
HIV does not affect the course of pregnancy in women who are receiving treatment. The virus also does
not affect the health of the baby during pregnancy, unless the mother develops an OI.
If you have just been diagnosed with HIV…
Finding out either that you are pregnant or that you are HIV-positive can be overwhelming on its own. It
can be even more difficult if you find out both at the same time.
Both pregnancy and HIV care involve many new words and terms. We try our best to be clear about what these
terms really mean and how they might affect your life.
On an optimistic note, it is likely that no matter how difficult things seem now, they will get better and easier. It is
very important and reassuring to understand the great progress made in treating HIV. This is especially true for
treatment in pregnancy.
The decisions that you make about your pregnancy are very personal. Having as much information as
possible will help you make informed choices. The only 'correct' decisions are those that you make
yourself.
can be even more difficult if you find out both at the same time.
Both pregnancy and HIV care involve many new words and terms. We try our best to be clear about what these
terms really mean and how they might affect your life.
On an optimistic note, it is likely that no matter how difficult things seem now, they will get better and easier. It is
very important and reassuring to understand the great progress made in treating HIV. This is especially true for
treatment in pregnancy.
- There are lots of people, services and other sources of information to help you. Sources of additional
info.
- The advice that you receive from these sources and others may be different than that given to pregnant
women generally. This includes information on: HIV medicines, delivery and Caesarean section and breast-
feeding.
- Most people with HIV have a lot of time to come to terms with their diagnosis before deciding about
treatment. This may not be the case if you were diagnosed during your pregnancy. You may need to make
some difficult decisions more quickly.
- Ask lots of questions.
- Take your partner or a friend with you to your appointments.
- Try to talk to other women who have been in your situation.
The decisions that you make about your pregnancy are very personal. Having as much information as
possible will help you make informed choices. The only 'correct' decisions are those that you make
yourself.
© 2007 Abesha Care Inc. All Right Reserved. office@abeshacare.org
Information on this website is provided as a guide only. All treatment decisions should be taken in consultation with
your doctor or other healthcare professional.
REFERENCE:
!.1. Written by Polly Clayden and Simon Collins. Edited by Jeff Hoover. Drawings by Beth Higgins. Produced by HIV
i-Base.
your doctor or other healthcare professional.
REFERENCE:
!.1. Written by Polly Clayden and Simon Collins. Edited by Jeff Hoover. Drawings by Beth Higgins. Produced by HIV
i-Base.
 | |  | |  | |  | |  | |  | |  | |  | |  |
A guide to HIV, pregnancy & women's health