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Pregnancy and HIV

April 24, 2015

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HIV Drugs and Pregnancy

Deciding when to start treatment depends on your own health and when you find out you are pregnant. There are certain drugs that, according to the DHHS, should be avoided or used with caution because of possible side effects in the mother or the developing baby. Some examples are the combination of Videx (didanosine, ddI) and Zerit (stavudine, d4T) or the combination of Zerit and Retrovir (zidovudine or AZT). Viramune (nevirapine) should not be started in women living with HIV who have CD4 cell counts over 250.

It is important that you discuss the risks and benefits of the HIV drugs with your health care provider so that you can decide which treatments are best for you and your baby. In the US, your health care provider can call the National Perinatal HIV Hotline at 1-888-448-8765 for free, expert advice on all aspects of caring for pregnant women living with HIV.

The DHHS's pregnancy guidelines make the following recommendations:

For Women Living With HIV and Not Taking HIV Drugs

  1. When HIV treatment is needed for the health of the woman, she should receive a combination of HIV drugs based on treatment guidelines for non-pregnant adults. Treatment should include at least one nucleoside/nucleotide reverse transcriptase inhibitor (NRTI) that can pass through the placenta (the organ that nourishes the baby in the womb). HIV treatment should start as soon as possible, including in the first trimester (three months) of pregnancy.
  2. When HIV treatment is not needed for the health of the woman: she should also receive combination HIV treatment to prevent perinatal transmission. At least one NRTI drug that can pass through the placenta should be included in the combination. Women in the first trimester may consider waiting to start the HIV drugs until after the first 10–12 weeks (first trimester) of pregnancy.

Deciding whether to start taking HIV drugs during the first trimester will depend on several factors, including a woman's CD4 count, viral load, and medical conditions (e.g., nausea and vomiting). While starting HIV treatment earlier may be more effective for reducing transmission, it is important to weigh this against potential effects of exposing the developing baby to HIV drugs during the first trimester.

It is important that HIV drug treatment continue during labor and delivery. Women with viral loads of 1000 or more should receive intravenous (IV) administration of Retrovir (zidovudine), regardless of their HIV drug regimens during pregnancy or their modes of delivery. Women with a viral load of less than 1000 do not need to receive intravenous Retrovir.

After delivery, the baby should receive liquid Retrovir for six weeks. When the mother has received HIV drugs and remained virally suppressed, health care providers may consider giving the baby four weeks of liquid Retrovir.

After the birth of the baby, it is important for the mother to talk with her health care provider about the risks and benefits of continuing her own HIV treatment. The DHHS recommends that all adults, including new mothers, receive HIV drugs regardless of CD4 count.

For Women Living With HIV Who Are Already Taking HIV Drugs

Women in this situation should continue taking their current HIV drugs if they are working well to control the virus and have not been show to harm the pregnant mother or developing baby. Unnecessary switching of HIV drugs can lead to loss of viral control and thus increase the risk of passing HIV to the developing baby.

If a viral load test shows that the drugs are not working, switch to a more effective combination. The drugs should be continued during labor and delivery, during which time IV Retrovir should also be given to the mother if she has a viral load of 1000 or more. Women with a viral load of less than 1000 can continue to take their current regimen. After delivery, the baby should receive liquid Retrovir for four or six weeks.

For HIV+ Pregnant Women in Labor Who Have Not Taken HIV Drugs

A woman in labor who has not taken HIV drugs can still reduce the risk of perinatal transmission using HIV drugs during labor and delivery and to treat the baby for a short time after birth. The DHHS guidelines recommend the following:

  • IV Retrovir for the mother during labor and a combination of six weeks of Retrovir plus three doses of Viramune in the first week of life (at birth, 48 hours after birth, and 96 hours after the second dose) for the baby

After the baby is born, it is recommended that the mother be evaluated to determine whether HIV treatment is recommended for her.

For Babies Born to Women Living with HIV Who Have Not Taken HIV Drugs Before or During Labor

The baby can still receive treatment to reduce the risk of transmission. The DHHS guidelines recommend the following:

  • A combination of six weeks of Retrovir plus three doses of Viramune in the first week of life (at birth, 48 hours after birth, and 96 hours after the second dose)

After the baby is born, it is recommended that the mother be evaluated to determine whether HIV treatment is recommended for her.

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This article was provided by The Well Project. Visit The Well Project's Web site to learn more about their resources and initiatives for women living with HIV. The Well Project shares its content with TheBody.com to ensure all people have access to the highest quality treatment information available. The Well Project receives no advertising revenue from TheBody.com or the advertisers on this site. No advertiser on this site has any editorial input into The Well Project's content.
 

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