Guide to HIV, Pregnancy and Women's Health: Prevention and Treatment of Other Infections
Treatment and prophylaxis for most opportunistic infections during pregnancy is broadly similar to that for non-pregnant adults. Only a few drugs are not recommended.
You may need to be treated for other infections, especially if you are diagnosed with HIV during pregnancy.
Prophylaxis against CMV, candida infections, and invasive fungal infections is not routinely recommended because of drug toxicity.
Treatment of very serious infections should not be avoided because of pregnancy.
Pregnant women are at an increased risk for flu and should be vaccinated regardless of whether they are HIV positive or negative. They should be given the flu vaccine (containing season and H1N1 vaccines).
Live vaccines including measles, mumps and rubella should not be used during pregnancy.
If you have HBV you will need to take an ART regimen that includes tenofovir and either FTC or 3TC as they act against HBV as well as HIV.
You will also be vaccinated against HAV after the first trimester.
If your CD4 was less than 500 when you started ART you should continue taking it after delivery. If it is above 500 you might also consider continuing. If you do decide to stop you will need to have your liver function carefully monitored.
If your liver is already damaged -- even if you are above 500 you should continue ART.
If you are coinfected with hepatitis C virus (HCV) and HIV -- you may discover this through routine screening in pregnancy -- there is a risk of transmission of HCV of up to 15 percent. Treating your HIV will reduce this risk of transmitting HCV. You will need to take ART regardless of your CD4 count.
Mothers with HCV should not be treated with pegalated interferon or ribarvirin. If you discover you are pregnant while being treated with these drugs, they should be stopped.
Your HCV will need to be carefully monitored.
You will be vaccinated against HBV and HAV.
If your HIV viral load is undetectable on ART you can have a vaginal delivery.
If your CD4 was 350 to 500 before you started ART should continue to take it after your baby is born regardless of your liver damage through HCV.
You should continue too if your CD4 is less than 500 and your liver is damaged. If your HCV has not progressed yet and your CD4 is greater than 500 you could stop ART unless you need it for another reason. But if your liver is damaged continuing ART is preferable.
i-Base has a guide on "Hepatitis C for People Living With HIV."
It is important to treat TB in pregnancy. Additionally HIV/ TB coinfection increases the risk of vertical transmission of both infections. TB can also increase the risk of the less common in utero (in the womb rather than during labour) vertical transmission of HIV.
Like HIV, TB is a much greater risk to a pregnant woman and her infant than its treatment or prophylaxis.
Most TB first line TB drugs are safe to use in pregnancy.
However, the TB drug streptomycin is not recommended in pregnancy as it can cause permanent deafness in the baby.
This drug is now only rarely used in the treatment of TB in the UK.
Many women with HIV also have genital herpes. HIV positive mothers are far more likely to experience an outbreak of herpes during labour than negative mothers. To reduce this risk, prophylaxis treatment for herpes with acyclovir is often recommended.
Herpes is very easily transmitted from mother to child. Even if someone has a HIV viral load that is below detection on combination therapy, herpes sores contain high levels of HIV. The herpes virus can also be released from the sores during labour. This will put the baby at risk from neonatal herpes and at increased risk of HIV.
Prophylaxis and treatment with acyclovir is safe to use during pregnancy.
More From This Resource Center
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What Every HIV-Positive Woman Should Know About GYN Care and Prevention
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