HIV infection was once a death sentence. HIV in pregnancy was particularly dangerous, and the risk of an infected mother passing the infection to her baby was more than 25%. Today, HIV infection is considered to be more of a chronic condition. If recognized and treated, people who carry this virus may live long lives. And pregnant women with HIV can have successful pregnancies and healthy babies. Here are some facts about HIV infection in pregnancy, along with updated treatment recommendations:
- In 1987, AZT (zidovudine) was the first effective medication approved to treat HIV. In 1994, AZT was studied in pregnancy. With AZT treatment, the risk of an infected mother passing the virus to her baby was reduced from more than 25% to less than 8%. Today, with even better medications, the risk of mother-baby transmission is less than 2%.
- In 2006, 48 states approved “opt-out” testing for HIV in pregnancy. Opt-out testing means that, unless you specifically decline testing, you will be screened for HIV during your pregnancy. This automatic screening has improved detection of HIV in pregnancy from less than 50% to more than 90%. And improved detection means healthier moms and fewer infected babies.
- Treatment for HIV in pregnancy is much more effective when started as early as possible; ideally, prior to pregnancy. The lower your HIV blood level (viral load) is, the less likely you are to pass the infection to your baby. If you are on treatment prior to pregnancy and have a low viral load, the chance of having an infected baby is less than 1%.
- Today, treatment for HIV is sophisticated. Patients with HIV infection need to be on at least 3 medications – 2 nucleoside reverse transcriptase inhibitors (NRTIs) plus a protease inhibitor or integrase inhibitor. Most of these meds can be taken just once daily, and many come in combination pills, making it much easier to remember to take your medicine. Your medications will be tailored to you by testing your blood for resistance to many antiviral medications.
- If you have HIV infection, you MUST take your medicines faithfully, especially in pregnancy. Even one missed dose can increase the chance that you will develop resistance to your medications. This means that your medications may need to be changed to other, potentially more dangerous, medications.
- HIV viral load is tested from time to time during the pregnancy, and will be repeated again in the last month. If your viral load is low, you may be a candidate for vaginal delivery. If the viral load is high, cesarean delivery is recommended. Usually, this is scheduled before labor starts, about 2 weeks before your due date.
- Up to 75% of babies who become infected with HIV acquire the infection during the delivery. For this reason, newborn babies of moms with HIV are treated for several weeks with medications, to reduce the risk of becoming infected.
- After you have your baby, continue your medications. A recent study discovered that 40-50% of moms with HIV did not stay on their medications after delivery. This statistic is astonishing! Remember that, in order to be a good mom and live to raise your baby, you have to keep yourself healthy.
If you have HIV and are pregnant or planning pregnancy, contact your health provider now, so that you can make sure you are on the medication regimen that best lowers your viral load. And take heart – current treatments can be very effective, making your future more positive than ever before.