Well, as
you suspected, your pregnancy test is positive. Congratulations!
Pregnancy can be an exciting time, and a really wonderful experience.
Of course, now
that you’re expecting, you probably have lots of questions, some of
which relate to how your HIV-positive status will impact your pregnancy
and your baby.
The goal in
every pregnancy is to keep both mom and baby healthy, and I’m happy to
say that this is a goal that’s well within your reach. Just because you
have HIV does not mean you can’t have a happy, healthy pregnancy, and a
happy, healthy baby. Basically, the same things that keep you healthy
will keep your baby healthy. Risks of transmitting the virus to your
baby decrease as your own viral load decreases.
So let’s talk
about what you need to do to keep both you and your little one healthy.
Many women wonder how HIV can be transmitted to the baby. HIV can be
transmitted during pregnancy, during labor and delivery, or by
breastfeeding. We’ll talk about what you can do during pregnancy, during
labor, and after your baby is born to decrease the chances of
transmitting the virus.
THE RIGHT DOCTOR AND THE RIGHT TESTS
It can be very
helpful to have an obstetrician with experience treating HIV-positive
women, in part because the decisions regarding whether to use certain
“invasive” genetic tests can be difficult. Many pregnant women undergo a
variety of screening tests
Because these
tests are invasive, they involve at least a theoretical increased risk
of transmitting the virus to the baby. To date, there have been 159
reported invasive procedures on HIV-positive moms with no transmission
of HIV to the baby. In all cases, women were on HAART (highly active
antiretroviral therapy) with undetectable viral loads and though no
transmissions of HIV have occurred, a small increase in risk can’t be
ruled out. Therefore, any HIV-positive woman undergoing any invasive
procedure should be on HAART and have an undetectable viral load at the
time of the procedure.
Some experts
consider CVS too risky to offer to their HIV-positive patients and
recommend limiting invasive procedures to amniocentesis only, but
existing data on transmission risk associated with these procedures are
limited. Invasive testing procedures should be discussed thoroughly with
your OB and between you and your partner. Your OB (or genetic
counselor) will discuss the pros and cons of invasive testing with you.
But ultimately, whether to test (or not to test) is a personal decision.
HOW TO REDUCE THE RISK OF TRANSMITTING HIV TO YOUR BABY DURING PREGNANCY
Keeping your
viral load low is important during pregnancy to reduce the risk of
transmission. Regardless of what is recommended based solely on your
CD4+ and VL levels, you may want to start taking HIV meds as soon as you
learn you are pregnant. Yes, there are guidelines from the Department
of Health and Human Services (DHHS) that recommend when to start
treatment based on CD4+ and VL, but there are groups of people for which
treatment is recommended no matter what. Pregnant women are one of
those groups. We are trying to prevent your baby from becoming infected.
Earlier and
sustained control of HIV viral replication is associated with decreased
residual risk of transmission and favors initiating HAART drugs as early
in pregnancy as possible for all women.” In other words, starting HAART
(highly active antiretroviral therapy) drugs early to control the viral
load as much as possible decreased the chances that the virus would be
transmitted to the baby. In fact, we know that having an undetectable
viral load substantially lowers the risk of transmission of HIV to the
fetus and lessens the need for consideration of cesarean delivery
(C-section). That’s why it is always suggested that my patients start
HAART immediately after learning about their pregnancy.
So, if you are
not currently taking HIV medications (whether you are treatment-naive or
have taken them in the past), tell your HIV specialist about what
medications you’ve taken in the past and provide all laboratory tests
(genotypes, phenotypes, HLA B*5701) and be honest about any adherence
issues that you’ve had in the past. Also talk about any tolerability
issues and drug allergies you have had with any old regimen(s).
As soon as you
learn that you’re pregnant, you should contact your HIV specialist to
discuss your options for medication and to review what you’re currently
taking to make sure your medications are safe for the baby. If you are
taking HIV medication, like HAART, your clinician will likely continue
your treatment.
So there is a
lot to consider here, and you should have discussions with both your
obstetrician and HIV specialist to help determine what is best for you
and your baby. Assuming that you have an HIV specialist, your specialist
will refer you to an obstetrician who has experience with HIV-positive
mothers. If you don’t have a specialist, now might be a good time to
seek one out.
LOWERING THE RISK DURING LABOR AND DELIVERY
Again, the goal
is to limit the baby’s exposure to the virus. So it’s probably not
surprising that your options for labor and delivery depend upon your
viral load (another important reason to take your HIV meds as
prescribed). It is also recommended for women who did not receive HIV
medication during pregnancy. In these situations, ACOG recommends a
scheduled C-section at 38 weeks’ gestation in order to decrease the
likelihood of onset of labor or rupture of membranes before delivery.
To help prevent
transmission, your baby will be given liquid AZT immediately after
birth and this will be continued (by you at home) twice a day for six
weeks, HIV can also be transmitted to a baby through food that was
pre-chewed by an HIV-positive mother (or caretaker). To be completely
safe, babies should not be fed pre-chewed food.
DOES THE BABY HAVE HIV?
There are two
types of tests that will be performed on your baby to find out if he or
she has HIV. The first is the HIV antibody test. All babies born to a
mom with HIV will test positive for the first several months of their
lives. This does not mean that they have HIV. Rather, it means that the
baby has simply been exposed to his/her mother’s HIV. The second test,
PCR testing, looks for the virus and not just the antibodies to the
virus. It is this test that can tell whether the baby has HIV or not.
This test will be done during the first few days of his/her life.
The PCR test
will be repeated several times on your baby. To know for certain that
your baby is not infected with HIV, the baby must not be breastfeeding
and must have two negative PCR tests, the first at one month (or older)
and the second at four months (or older). Many experts confirm the
HIV-negative status of the baby with an HIV antibody test at age 12 to
18 months. To be diagnosed with HIV, a baby must have two positive PCR
tests.
Again, just
because you have HIV does not mean you can’t have a healthy pregnancy
and baby. In fact, obstetrician from Regency Medical Centre confirmed to
serve an HIV-positive patient who followed her regimen and had a
healthy pregnancy, and an uncomplicated vaginal birth. She and her
husband welcomed a healthy HIV-negative baby into the world. It can be
done, and it is done by lots of women.
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