HIV therapy during pregnancy

Should women take HIV treatment during pregnancy?

Yes. All pregnant HIV-infected women should take HIV medications during pregnancy to prevent mother-to-child transmission of the human immunodeficiency virus.  

Transmission of the human immunodeficiency virus from mother to child is also called perinatal transmission of HIV.

HIV medications work by preventing HIV from multiplying, which reduces the amount of virus in the body, also called viral load . A low viral load prevents the mother from contracting HIV infection to the child during pregnancy and childbirth. Also, a low HIV viral load helps maintain the health of the expectant mother.

Are HIV medications safe during pregnancy?

Most HIV medications are safe to take during pregnancy. An important point is that antiretroviral therapy for HIV does not increase the risk of congenital diseases in children.

When prescribing antiretroviral therapy for pregnant women with HIV, doctors consider the benefits and risks of specific HIV medications. Therefore, all pregnant women with HIV should start taking appropriate medications as soon as possible. If a woman undergoes antiretroviral therapy while not yet pregnant, it is necessary to continue treatment even in the event of pregnancy.

The choice of treatment for HIV infection during pregnancy depends on several factors, including:

• current or previously used HIV treatment;
• medical indications;
• drug resistance testing results.

In general, pregnant women with HIV infection can receive the same treatment regimens as other populations. Exceptions may be made for drugs that increase the risk of any side effects that are dangerous for pregnant women and infants.

However, in most cases, women who are already on an effective HIV treatment regimen should continue to use the same regimen throughout their pregnancy. 

Do I need to take HIV medications during childbirth?

Yes, because the baby is exposed to the human immunodeficiency virus in the mother's blood and other body fluids as it passes through the birth canal.

Taking anti-HIV therapy before and during childbirth virtually prevents the risk of transmission of the human immunodeficiency virus from mother to baby through the placenta.

Women with an unknown or high viral load (more than 1,000 copies/ml) should be given an HIV medicine called zidovudine by intravenous infusion closer to the time of delivery.

Zidovudine easily passes from a pregnant woman to her unborn child through the placenta and protects him from contracting HIV infection during childbirth. Also, the use of zidovudine during labor prevents transmission of HIV to the baby, even in women with a high viral load.

Does caesarean section reduce the risk of mother-to-child transmission of HIV?

Yes, a planned cesarean section can reduce the risk of perinatal HIV transmission in women with an unknown or high viral load (more than 1000 copies/mL). As a rule, in order to reduce the risk of perinatal HIV infection, a cesarean section is scheduled for the 38th week of pregnancy, that is, 2 weeks before the expected due date.

However, it is unknown whether elective caesarean section can reduce the risk of mother-to-child transmission of HIV infection in pregnant women with a viral load of less than 1000 copies/mL. Also, regardless of viral load, a woman with HIV can have a cesarean section for other medical reasons.

Remember that only a doctor is competent to decide which HIV medications to use during childbirth, and whether a caesarean section should be prescribed in a particular case to prevent mother-to-child transmission of HIV.

Do I need to continue taking HIV medications after giving birth?

Prenatal care for women with HIV includes counseling about the benefits of continuing to take anti-HIV medications after birth. Taking medications to treat HIV throughout your life prevents HIV infection from progressing to AIDS (acquired immunodeficiency syndrome), and also reduces the risk of transmitting HIV to other people.  

Babies born to HIV-infected women usually receive zidovudine for 4–6 weeks after birth. In certain situations, the infant may receive other HIV medications in addition to zidovudine.