- Pregnancy, childbirth & breastfeeding and HIV
- How do I know if I have HIV?
- How can I prevent passing HIV on to my baby?
- Taking antiretroviral treatment to protect your baby
- Protecting your baby during childbirth
- HIV and breastfeeding
- Does my baby have HIV?
- HIV/AIDS during pregnancy
- How does HIV spread?
- What are the symptoms of HIV and AIDS?
- Should I be tested for HIV during my pregnancy?
- How can I be sure my HIV test result is accurate?
- How can I protect my unborn baby from HIV?
- What happens if a pregnant woman is HIV positive?
- Will I need to have a C-section if I have HIV?
- How can I cope with the stress of being HIV positive and pregnant?
- How can I avoid getting HIV?
Pregnancy, childbirth & breastfeeding and HIV
- A pregnant woman living with HIV can pass on the virus to her baby during pregnancy, childbirth and through breastfeeding.
- If you are a woman living with HIV, taking antiretroviral treatment correctly during pregnancy and breastfeeding can virtually eliminate the risk of passing on the virus to your baby.
- Attending antenatal appointments means you can get tested for HIV and if needed receive treatment and medical advice to help keep you and your baby healthy.
If you are a pregnant woman living with HIV there are a number of ways that HIV might be passed on to your baby. HIV in your blood could pass into your baby’s body. This is most ly to happen in the last few weeks of pregnancy, during labour, or delivery. Breastfeeding your baby can also transmit HIV, because HIV is in your breastmilk.
There is a 15 to 45% chance of passing HIV on to your baby if neither of you take HIV treatment.
However, taking the correct treatment during your pregnancy and while you breastfeed can virtually eliminate this risk.
How do I know if I have HIV?
If you are pregnant, it is important to attend your antenatal appointments, as these are the times when you can get an HIV test.
Your healthcare professional will offer you a test at your first appointment. If the result is positive you will be encouraged to start antiretroviral treatment as soon as possible.
You will also be offered a test in your third trimester (from 28 weeks).
Remember that, whether you are pregnant or not, if you do have HIV you may not show any symptoms.
The only way to know whether you are HIV-positive is to get tested.
If at any point during your pregnancy or breastfeeding stage you think you have been exposed to HIV, you may be able to take post-exposure prophylaxis (PEP).
You need to take PEP within 72 hours of possible exposure to prevent HIV from establishing in your body and being passed on to your baby.
If you’re breastfeeding, you should discuss whether or not to continue breastfeeding with your healthcare professional.
If you are pregnant, it is important to attend your antenatal appointments, as this is where you can get an HIV test.
How can I prevent passing HIV on to my baby?
If your HIV test result is positive, there are a number of things you can do to reduce the risk of passing on HIV to your baby.
Taking antiretroviral treatment to protect your baby
Taking treatment properly can reduce the risk of your baby being born with HIV to less than 1%.
If you knew that you were HIV-positive before you got pregnant, you may be taking treatment already. If you are not, talk to a healthcare professional about starting treatment as soon as possible.
If you found out that you living with HIV during your pregnancy, it is recommended that you start treatment as soon as possible and continue taking it every day for life.
Your baby will also be given treatment for four to six weeks after they are born to help prevent an HIV infection developing.
Protecting your baby during childbirth
If you take your treatment correctly, it will lower the amount of HIV in your body. In some people, the amount of HIV in their body can be reduced to such low levels that it is said to be ‘undetectable’ (undetectable viral load).
This means that you can plan to have a vaginal delivery because the risk of passing on HIV to your baby during childbirth will be extremely small.
If you don’t have an undetectable viral load, you may be offered a caesarean section, as this carries a smaller risk of passing HIV to your baby than a vaginal delivery.
If your HIV test result comes back positive, there are a number of things you can do to reduce the risk of passing HIV to your baby.
I was diagnosed with HIV. After a few years I entered a relationship and we decided to have children. My HIV consultant assured me that it was fine since my viral load was undetectable. I had my twins through C-section, which was planned.
HIV and breastfeeding
Breastmilk contains HIV. However, guidelines on whether or not to breastfeed vary depending on what resources are available to you.
If you always have access to formula and clean, boiled water, you should not breastfeed and give formula instead.
If you do not have access to formula and clean, boiled water all of the time, you may be advised to breastfeed while both you and your baby are taking antiretroviral treatment.
If you do breastfeed, you must always take your treatment and exclusively breastfeed (give breastmilk only) for at least six months. Mixing breastmilk and other foods before this time increases your baby’s risk of HIV. You can mix-feed your baby after six months.
As every person’s situation is different, it is best to talk to a healthcare professional to get specific advice.
Does my baby have HIV?
Your baby should be tested for HIV at birth, and again four to six weeks later.
If the result comes back negative, your baby should be tested again at 18 months and/or when you have finished breastfeeding to find out your baby’s final HIV status. It is very important to take your baby for this final HIV test to ensure they are HIV-negative or to get them on treatment if they are positive.
If any of these tests come back positive, your baby will need to start treatment straight away. Talk to your healthcare professional, and attend follow-up appointments to ensure your baby receives treatment.
HIV/AIDS during pregnancy
HIV stands for human immunodeficiency virus. HIV attacks the body's immune system, gradually destroying its ability to fight infections and certain cancers.
Left untreated, HIV can develop into acquired immunodeficiency syndrome (AIDS). This is the most severe stage of HIV and is usually fatal.
There's currently no cure for HIV. However, medication can slow the progression of HIV and delay the onset of AIDS. Many people diagnosed with HIV today stay healthy for many years and have a nearly normal life span.
The U.S. Centers for Disease Control and Prevention (CDC) estimates that 1.2 million people in the United States are infected with HIV. About 38,000 new infections occur each year, and 19 percent of them occur in women. One in nine women with HIV are not aware they have it.
About 5,000 women with HIV deliver infants each year in the United States.
How does HIV spread?
HIV is found in blood and other body fluids including semen, vaginal fluid, and breast milk. To be infected with HIV, fluid from an infected person has to get into your bloodstream.
Ways for a woman to become infected with HIV:
- Having unprotected sex with an HIV-positive man. This is the most common way. The infection can pass from the man's semen through the thin mucous lining of the vagina. Having unprotected anal sex with an infected partner or giving oral sex to an infected man also carry a high risk of infection. You can also become infected by deep kissing when both you and your infected partner have mouth sores.
- Sharing needles or syringes
- Being cut by a sharp object contaminated with HIV
- Receiving a transfusion with infected blood. However, the risk of becoming infected this way is extremely rare, approximately one in a million, because all blood products are screened for the virus and treated with high heat to eliminate germs.
If you're HIV positive, you can pass the virus to your baby through the placenta during pregnancy. You can also expose your baby to HIV in your blood and other fluids when your water breaks and during labor and delivery. And you can transmit the virus while breastfeeding.
However, if your viral load is low (the amount of the HIV virus in your body is low) and your infection is controlled, your risk of transmitting the virus to your baby is quite low.
You can't give your baby HIV by hugging or touching, sharing towels, or through sweat, saliva, or tears.
What are the symptoms of HIV and AIDS?
Some people have no symptoms when they first become infected with HIV. Others develop temporary flu- symptoms in the first few weeks after being exposed to the virus. These symptoms may not seem significant at first because they're similar to flu and generally get better without treatment.
HIV symptoms include:
- Sore throat
- Swollen glands
It can take as long as 10 years after infection to develop severe symptoms caused by the effect of the virus on your immune system. During this time, most people experience a gradual reduction in the number of CD4 cells in their blood. (CD4 cells are the immune system's key infection fighters.)
Healthy adults have between 500 and 1,200 CD4 cells in every cubic millimeter (mm) of blood. A person with fewer than 200 cells per mm starts to develop serious, unusual infections called opportunistic illnesses and has progressed to AIDS.
Symptoms of AIDS include:
- Swollen lymph glands
- Rapid weight loss
- Frequent fevers and sweating
- Persistent or frequent sores in the mouth or vagina
- Extreme and unexplained tiredness
Should I be tested for HIV during my pregnancy?
Absolutely. The CDC, American College of Obstetricians and Gynecologists (ACOG), and many other organizations recommend that all pregnant women be tested for HIV as early as possible. If you're not offered an HIV test at your first prenatal visit, ask for one.
If you're HIV positive, getting proper treatment can significantly reduce your risk of spreading the virus to your baby and is crucial to protect your own health. The sooner you start treatment the better.
If you're at high risk for an HIV infection, or if your state or other guidelines recommend or require it, you'll be tested again in your third trimester. You're at high risk for HIV if:
- You're in a relationship with a new sexual partner
- You don't know the HIV status of your new sexual partner
- You or your partner inject drugs
- You exchange sex for money or drugs
- Your partner is HIV positive
Although it's best for both you and your baby for you to begin treatment during pregnancy, getting treatment later is better than not being treated at all.
If you haven't been tested during pregnancy, or you're at high risk and your status is unknown at the time of admission, your healthcare provider may recommend rapid HIV testing when you're admitted to the hospital for labor and delivery.
Rapid HIV testing can rule out the condition within 30 minutes, though you'll need another test to confirm the diagnosis if you get a positive result.
If you're found to be HIV positive, your care team can take immediate precautions to reduce the risk of transmitting HIV to your baby during childbirth.
If you're HIV positive, your baby will be tested at birth. (This may also happen if you weren't tested at all before delivery.) Starting your baby on antiretroviral medication within six hours of birth is ideal to prevent transmission. Your baby will be tested for HIV again several times in the first few months and again when they are 12 to 18 months old.
How can I be sure my HIV test result is accurate?
HIV tests are generally very accurate. However, if you think you've recently been exposed to HIV, you'll need to wait several weeks before a test is able to detect the virus.
There are several types of HIV tests. Most tests check your blood for the presence of HIV antibodies, or a combination of antibodies and antigens. Your immune system produces antibodies to HIV in response to being exposed to the virus. It takes between three and 12 weeks for your body to make enough antibodies to show up in a test.
Antigens are the part of the virus that antibodies respond to. Because antigens show up faster than antibodies, a test that looks for both antigens and antibodies can detect HIV sooner, usually between two and six weeks after a possible exposure.
If the first test is positive, the result will be confirmed by a second test. A false positive is when the result of the initial HIV test is positive, but the second one is negative. The final interpretation of these tests is negative. These are rare but can happen. You'll have two tests, so you can be sure of the result.
How can I protect my unborn baby from HIV?
The best way to protect your baby from HIV is to get tested and get treatment as soon as possible.
Thanks to advances in treatment and prevention, the number of HIV infections passed from mother to baby has declined by more than 95 percent in the United States since the early 1990s.
Fewer than 200 babies are born with HIV in the United States each year.
This number would be even smaller if all women were tested for HIV prior to conceiving or early in pregnancy, so they could be treated early.
Getting HIV treatment (a regimen of anti-HIV drugs) during pregnancy can help protect your health and prevent you from passing the virus to your baby by decreasing your viral load. With appropriate treatment during pregnancy, your baby's risk of being infected can be reduced to less than 1 percent.
To protect your baby, appropriate treatment might include:
- Taking HIV medication, called Highly Active AntiRetroviral Therapy (HAART), exactly as your provider prescribes during pregnancy and in labor. HAART medications stop the virus from multiplying. Taking them as scheduled can reduce your viral load so that HIV becomes undetectable, which means the risk of transmitting HIV is minimal.
- Having a c-section if the amount of HIV in your blood is at an unsafe level at the end of pregnancy.
- Not breastfeeding your baby.
- Giving your baby antiretroviral treatment (if you're infected) as prescribed. The medication regimen depends on your viral load and specific risk factors.
What happens if a pregnant woman is HIV positive?
If you're HIV positive and pregnant, it's important to get treatment. The goal of HAART is to reduce your viral load to an undetectable level. This protects your health and makes it less ly that HIV will spread to your baby. It can also reduce the chances of infecting your partner if they are HIV negative.
If you're already on HAART when you discover you're pregnant, don't stop taking medication. A lapse in treatment may cause the virus to become more resistant. Instead, consult your healthcare provider immediately.
In the past, HAART was usually only recommended once the viral load (the amount of HIV in your body) and CD4 count suggested that the immune system was compromised. Now the recommendation is to begin HAART as soon as possible after diagnosis. So if you haven't already started it, or if you've just been diagnosed, your provider will ly recommend that you begin right away.
It's possible to have an undetectable viral load between three and six months after starting HAART. Your care provider will check your viral load at least every month during your pregnancy until it's undetectable. After that, you'll be checked once every three months.
Side effects of HIV drugs can include:
- Muscle ache
- Liver damage
- Bone problems such as osteoporosis
Will I need to have a C-section if I have HIV?
Not necessarily. If your viral load is undetectable at the end of your pregnancy, the risk of transmitting HIV to your baby during a vaginal birth is very low.
You wouldn't need to have a c-section unless there were other reasons that you needed one.
If you have a high viral load near the end of your pregnancy, however, it might be necessary to have a cesarean to help prevent HIV transmission to your baby.
If you're HIV positive with AIDS, you may be at greater risk of infection if you have a cesarean delivery, because women with low CD4 counts have weakened immune systems. You'll be given antibiotics to prevent infection during a cesarean delivery.
How can I cope with the stress of being HIV positive and pregnant?
Being pregnant can be stressful under the best of circumstances. But being pregnant when you have a high-risk condition such as HIV can make it even more so, especially if you've just been diagnosed.
Although it can be difficult, focusing on your health right now is the best way to protect your baby from HIV. And it will help you stay well enough to care for your baby as they grow up.
Pay attention to your mental health as well. Let your caregiver know if you're feeling overly anxious or depressed so you can get a referral to a mental health professional, an HIV support group, or both.
How can I avoid getting HIV?
If you're concerned you may be at risk of getting HIV, there are steps you can take to protect yourself:
- Unless you're sure that your partner is HIV negative, use condoms correctly every time you have sex. That applies whether it's vaginal, oral, or anal sex.
- Use only water-based lubricants with condoms. Oil-based lubricants can weaken latex and cause it to break.
- If your partner is HIV positive, talk to your healthcare provider about pre-exposure prophylaxis (PrEP), which involves taking medication to protect you from HIV if you're at high risk. PrEP doesn't replace the need to use condoms.
- Avoid contact with anything (such as needles or razors) that might be contaminated with infected blood.
- Never share needles or injection equipment with others. If you abuse injection drugs, get help quitting.
If you know you have HIV, reach out to a local maternal fetal medicine specialist (MFM) who's comfortable with and knowledgeable about HIV medications and pregnancy management. Visit the Society for Maternal-Fetal Medicine's website for more information and to find an MFM specialist near you.