Your Ability to Start and Maintain

Women and HIV Treatment

Pregnancy

One of the greatest successes of HIV treatment is our ability to prevent passing HIV from mother to baby during pregnancy or birth, provided the woman has ongoing access to care and treatment. Several things should be considered when taking HIV meds during pregnancy: ensuring the health of the woman, protecting the baby, when to start, drug choice and drug side effects.

It's important that the doctor you choose is experienced with HIV, women and pregnancy. The US Guidelines recommend that all HIV-positive pregnant women be on treatment, regardless of CD4 count or viral load. Some doctors recommend that women with early-stage HIV disease not start treatment during their first trimester, when the baby's organs are developing. You should weigh these benefits and risks with your doctor.

Some conditions, like diabetes, are common in pregnant women. Some HIV meds may worsen these conditions to some degree. A few HIV meds should not be taken during pregnancy, including Sustiva (due to its risk of birth defects), and Viramune (which may cause severe liver disease in women with CD4s above 250).

If protease inhibitors are used, their dose may need to be increased during the third trimester. It's recommended that Retrovir be included due to its ability to prevent trans­mission, unless the woman develops severe side effects, or is resistant to it, or is also using Zerit. Videx + Zerit should not be used.

Breast-Feeding

HIV is present in breast milk and may be passed from mother to child during breast-feeding. Therefore, the US Guidelines recommend that mothers use formula to feed newborns. This works best when there is easy and ongoing access to formula as well as clean water and refrigeration. HIV meds may be passed through breast milk, although this has not been well studied for all drugs. Women should consult experienced maternity doctors to fully explore their options. Acredited national or local breast milk banks may also be an option and may meet the infant's need for breast milk.

Contraceptives

Many HIV meds, mostly protease inhibitors and NNRTIs, can interact with hormonal birth control pills (those that contain (ethinyl estradiol, norethindrone). These interactions can alter the potency of the birth control pill or HIV meds. In this case, women may consider other HIV meds or use another form of birth control instead of, or in addition to, the pill. Less is known about how HIV meds interact with the transdermal patch or vaginal ring interacts with HIV meds.

Power of the Mind

The power of the mind in health and healing can really make a difference over time. Nearly two out of three people in clinical studies who take a placebo (a sugar pill with no medicinal value) get some of the same benefits as people taking a real drug. This is because they believe that what they're taking is good for them. This can also apply to HIV-related medications and alternative therapies.

If you believe that a particular medicine is "poison," chances are you'll experience side effects and won't do as well on it. On the other hand, if you believe that something you're taking is good for you, then you'll more likely have an overall better experience with the treatment and perhaps experience fewer side effects.

In exploring your beliefs about a medicine, you might find you've come to a conclusion based on fears or rumors. Grounding yourself in facts, rather than fears, is critical to making good decisions. Personal experience and knowledge about a given medicine is far better information to inform your decisions than fears or conjecture.