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HIV/AIDS Resource Center for Women
Michelle Lopez Alora Gale Precious Jackson Nina Martinez Gracia Violeta Ross Quiroga Loreen Willenberg  
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Pregnancy and HIV

March 1, 2017

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HIV Drugs and Pregnancy

Most HIV drugs are safe when taken during pregnancy, and studies have shown that the developing baby is healthier when the mother begins HIV treatment before getting pregnant. In general, pregnant women living with HIV can take the same HIV treatment recommended for women who are not pregnant.

However, there are certain drugs that 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.

Though there used to be some debate about the safety of taking efavirenz (brand name Sustiva; also found in Atripla) during early pregnancy, the DHHS's October 2016 guidelines are now consistent with the guidelines of the World Health Organization (WHO) and the British HIV Association. All organizations suggest that efavirenz can be taken throughout pregnancy, including during the first trimester (12 weeks). In addition, women who are successfully virally suppressed on a treatment regimen containing efavirenz who become pregnant should continue on efavirenz throughout pregnancy.

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 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

It is important for a pregnant woman to take a combination of HIV drugs for her own health as well as to reduce the chances of passing HIV to her baby. HIV treatment should start as soon as possible. Many HIV drugs are safe when taken during pregnancy.

It is important that HIV treatment continue during labor and delivery. Women with viral loads of 1,000 or more should also receive intravenous (IV) administration of Retrovir, regardless of their HIV drug regimens during pregnancy or their modes of delivery. Women with a viral load of less than 1,000 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 during pregnancy 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. 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 1,000 or more. Women with a viral load of less than 1,000 can continue to take their current regimen and do not need the addition of IV Retrovir. After delivery, the baby should receive liquid Retrovir for four or six weeks.


For Pregnant Women Living With HIV Who Are in Labor and Have Not Taken HIV Drugs

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

  • For the mother: IV Retrovir during labor
  • For the baby: 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 start HIV treatment for her own health.


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 start HIV treatment for her own health.

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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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