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Mother-to-Child Transmission
Jun 2, 2004

I have read a bit about the transmission of HIV from the mother to the unborn fetus. My question is, even though there is no intermixing of the maternal and fetal blood in the placenta, is HIV incapable of traversing the placental barrier between fetus and mother? Have studies been done to look at this, and what are the chances? I am trying to decide whether or not my wife and I should continue our pregnancy since she tested HIV+ during a routine prenatal bloodwork. We are devastated by this, I am waiting to find out if I seroconvert in the next three months, and I do not want to be dealing with an HIV+ child for the rest of my miserable life.

Response from Dr. Luzuriaga

While we know that HIV transmission can occur during gestation, delivery, or after birth through brest feeding, the precise mechanisms of viral transfer are unknown. However, risk of infection increases as the placenta ages or with conditions (e.g., infection) that compromise the placenta, which suggests that most transmission occurs due to placental breakdown or admixture of maternal and fetal blood.

Nowadays, there is a lot that can be done to keep HIV positive moms healthy during pregnancy and to reduce the risk of mother-to-child HIV transmission (MTCT). Antiviral therapy is generally recommended to lower maternal viral load as much as possible and reduce the risk of MTCT. Women who are on therapy with undetectable viral loads have < 1% risk of transmitting the virus to their babies. Recommended regimens vary depending on maternal status (viral load, CD4 counts, etc). The Guide for the Use of Antiretroviral Therapy During Pregnancy (available on this web site under "Treatment Guidelines") provides an excellent review of MTCT and how to minimize the risk of transmission through antivirals and obstetrical practices.

Before you make any decisions, I would urge you to learn as much about MTCT as possible and discuss your options with a care provider who is experienced in caring for HIV positive women during pregnancy. Again, there is a plethora of information on this web site on MTCT (and its prevention), which should be helpful. Please don't hesitate to write again if further questions come up as you go along.


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