Guide to HIV, Pregnancy and Women's Health: Background and General Questions
The benefits of treatment are not just to your own health. Treating your own HIV will reduce the risk of your baby becoming HIV positive to almost zero.
Without treatment, about 25 percent of babies born to HIV positive women will be born HIV positive. One in four is not good odds, though, especially because modern HIV treatment can almost completely prevent transmission.
Reducing the risk of a baby becoming HIV positive was an early benefit of antiretrovirals. Although, pregnant women are often advised against taking medications, this is not the case with HIV treatment. This difference can sometimes seem confusing.
No one can tell you that it is completely safe to use antiretrovirals while you are pregnant but thousands of women have taken these medicines all over the world without any complications to their baby. This has resulted in many healthy HIV negative babies.
During your prenatal discussions, you and your doctor will discuss the benefits and risks of treatment options for you and your baby.
When most of everything felt right, my health and relationship, having a baby, after more than 20 years since my last child, was the best feeling. After discussions with my partner and my doctor, I decided to have a baby. We did this while continuing with my current meds and of course not breastfeeding.
I was determined to do everything in my power to have an HIV negative baby. Combination therapy has fulfilled my dreams of becoming a mother again.
-- Jenny, London
Your healthcare team also has access to an international birth defect registry. This has tracked birth defects in babies exposed to antiretroviral drugs since 1989.
So far, the registry has not seen an increase in the type or rate of birth defects, in babies whose mothers have been treated with currently used antiretrovirals, compared to the babies born to mums not using these drugs.
Pregnancy does not make a woman's HIV get any worse.
However, being pregnant may cause a drop in your CD4 count. CD4 cells are a type of white blood cell that helps our bodies fight infection. They are the cells that HIV infects and uses to make copies of itself. Your CD4 count is the number of CD4 cells in one cubic millimetre (written cells/ mm3 but in this guide we will just use the number eg 350) of blood. CD4 counts vary but an HIV negative adult would expect to have a CD4 count in the range of 400 to 1,600. Nearly all HIV treatment guidelines recommend starting treatment at 350 (and earlier in some cases).
The CD4 drop in pregnancy is usually about 50 cells/mm3, but it can vary a lot. This drop is only temporary. Your CD4 count will generally return to your pre-pregnancy level soon after the baby is born.
The drop should be a concern if your CD4 falls below 200. Below this level, you are at a higher risk from opportunistic infections. These are infections that occur after HIV has damaged your immune system.
These infections could affect both you and the baby, and you will need to be treated for them immediately if you get one. In general, pregnant women need the same treatment to treat and prevent opportunistic infections as people who are not pregnant.
Also sometimes if you start taking ART in pregnancy your CD4 count many not increase very much even though your viral load goes down. If this happens don't worry, your CD4 count will catch up after the baby is born.
HIV does not affect the course of pregnancy in women who are receiving ART.
The virus also does not affect the health of the baby during pregnancy, unless the mother develops an opportunistic infection.
This booklet is about HIV and pregnancy. Other important aspects of HIV treatment and care are described in detail in other i-Base guides, including:
- Introduction to Combination Therapy
- Guide to Changing Treatment
- HIV and your Quality of Life
- Hepatitis C for People Living With HIV
- Sexual Transmission and HIV Tests
These free booklets provide additional information on the basics of using and getting the best out of your treatment. They also explain in more detail words and phrases introduced in this one that may be unfamiliar or confusing, including CD4, viral load and resistance.
We hope that you will use all of these booklets together when you need them. Your clinic may have copies of any or all of them. You can also order them online.
i-Base provides a specialised HIV information service.
It is online at http://i-base.info/qa/ask-a- question?first=yes.
or by email at email@example.com.
Frequently asked questions about HIV and pregnancy are online at http://i-base.info/qa/faqs-on-having-a-baby.
There is also a free telephone information support service at the following number: 0808 800 6013. The service is available from 12 to 4 pm on Monday, Tuesday and Wednesday.
If you want to ask questions about HIV treatment and pregnancy, please contact us and we will try to help.
Please also talk to your health care team if you need additional support and information.
Good sources of community support:
From Pregnancy to Baby and Beyond peer support project at Positively UK. Women (and men) can either self refer or be referred by their clinic.
firstname.lastname@example.org or 02077130444.
Body and Soul -- a family HIV charity.
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