Guide to HIV, Pregnancy and Women's Health: Screening and Monitoring
Both pregnancy and HIV care require good monitoring.
HIV positive pregnant women do not need any extra monitoring, as far as HIV is concerned, compared to non- pregnant HIV positive women.
You will have a resistance test before you start ART (unless you are diagnosed very late). If you take a short course and stop another one is recommended then.
If you conceive on ART or do not need ART for your own health, you should have a minimum of one CD4 count before you start (or when you first discover you are pregnant if you are already on ART) and one at delivery.
Liver function tests should be done when you start ART and then at each antenatal visit.
If you do not achieve an undetectable viral load by 36 weeks some doctors may recommend TDM (therapeutic drug monitoring). TDM uses blood tests to check whether you are absorbing the correct amount of a drug. Drug levels, particularly of PIs can vary greatly between individuals and can be lower during pregnancy. Occasionally this can lead to a dose adjustment.
Your doctor will also discuss your adherence with you and perhaps do another resistance test. You might need an adjustment to your regimen.
You may also need to be screened for toxoplasmosis and cytomegalovirus (CMV). These are two common infections that can be transmitted to your baby. The tests should be performed as early as possible in your pregnancy. You should be treated for these if necessary.
Otherwise, tests will be fairly routine, and may vary slightly from doctor to doctor. Routine tests include blood pressure, weight, blood and urine tests as well as foetal monitoring.
An invasive test is a procedure or examination that needs the body to be entered in some way, either through a needle or with a tube. If a test is invasive and cannot be delayed until your viral load is undetectable, you will be recommended to start ART with raltegravir in the combination. You will also be given a single dose of nevirapine 2 to 4 hours before the procedure.
Unless you need extra care you will probably visit your clinic monthly for most of your pregnancy and every two weeks after the eighth month.
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