Guide to HIV, Pregnancy and Women's Health: Planning Your Pregnancy
Many HIV positive women become pregnant when they already know their HIV status.
Many women are also already taking ART when they become pregnant. If you already know that you are HIV positive, you may have discussed the possibility of becoming pregnant as part of your routine HIV care -- whether this pregnancy was planned or not.
If you are planning to get pregnant, your healthcare provider will advise you to:
- Consider your general health.
- Have appropriate check ups.
- Treat any sexually transmitted infections (STIs).
You should also make sure you are receiving appropriate care and treatment for your HIV. It is reassuring that over 98 percent of HIV positive pregnant women have uninfected babies in the UK currently.
Choose a healthcare team and maternity hospital that supports and respects your decision to have a baby.
In this section, as well as options for HIV positive women (with either negative or positive partners) wishing to get pregnant, we look at safer conception for HIV negative women with HIV positive partners.
Timing of Conception Attempt
Ovulation -- the most fertile time during a woman's menstrual cycle is when a mature egg is released from her ovary. The egg has a life span of about 24 hours. Conception is most likely to take place at this time.
Ovulation takes place about 14 days before the beginning of the woman's next menstrual cycle.
You are at your most fertile time the day before and the day of ovulation as the egg survives about 24 hours. This is when conception can take place.
The fertile period is usually about 5 days before ovulation (as sperm can survive in your body for several days) until about 2 days after ovulation. So the period that a woman is fertile is about 7 days.
There are different ways to estimate your fertile time, usually by taking your temperature (which increases at the beginning of ovulation), or by recording when you have your periods, in order to work out when you are ovulating (called the calendar method). Chemists sell ovulatory kits that can help you work this out.
Your healthcare team can explain to you how to do this.
Pre-Exposure Prophylaxis (PrEP)
This is when an HIV negative person takes antiretrovirals to prevent them from getting HIV. This method is sometimes recommended to help make a conception safer.
What to Do When One Partner Is HIV Positive and the Other Is HIV Negative
Recently there has been good news for couples in this situation.
In January 2013, BHIVA and the Expert Advisory Group on AIDS (EAGA) issued a position statement on the use of ART by HIV positive people to reduce HIV transmission.
The statement refers to a very large study that in 2011 reported some very important news. The results from the HIV Prevention Trials Network (HPTN) Study 052 provided proof that ART can make HIV positive people less infectious to their HIV negative partners.
The study was conducted in several countries with over 1700 couples where one partner was HIV positive and the other HIV negative. It compared the effect of starting ART immediately (CD4 count between 350 and 550) to delaying starting until the positive partner reached a CD4 count of less than 250.
The results showed that starting ART at higher CD4 counts lowered the risk of HIV transmission by a remarkable 96 percent. The study was stopped early as the benefits were shown more quickly than anticipated in the original design.
The BHIVA/EAGA statement notes that successful ART use by the HIV positive person is as effective as consistent condom use in limiting transmission.
Importantly, it stresses that this is provided the following conditions are met:
- Neither partner has another STI.
- The HIV positive partner has a viral load below 50 copies/mL for over 6 months.
- The HIV positive partner has regular viral load testing (3-4 monthly).
Health care professionals in the UK are recommended to discuss the impact of ART on transmission with HIV positive people and the possibility of starting ART for this purpose.
You can find the position statement on the Department of Health website.
Also in January 2013 a systematic review (when all the published research on a topic is looked at all together in order to answer a question) was presented of publications reporting rates of HIV transmission in heterosexual couples, when the positive partner had an undetectable viral load. This review included results from HPTN 052 an also found a minimum risk of transmission.
For many people these developments are very reassuring, particularly those who meet the ART and viral load conditions and choose to have sex without condoms.
Couples who generally use condoms will be advised that the recommended way of conception is by timed intercourse when the woman is most fertile. Sometimes the negative partner will be recommended to take PrEP.
Occasionally some couples might still be anxious about transmission with unprotected intercourse even though they meet the ART, adherence and viral load conditions. Or they might not meet the conditions. In these cases they might be recommended and consider other methods.