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Michelle Lopez Alora Gale Precious Jackson Nina Martinez Gracia Violeta Ross Quiroga Loreen Willenberg  
Michelle Alora Precious Nina Gracia Loreen  

Pregnancy and HIV

October 2012

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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. The pregnancy guidelines make the following recommendations:

For HIV+ Women 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. Retrovir should be used as one of the drugs in the combination if possible. 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 mother-to-child transmission. Retrovir should be used as one of the drugs in the combination, if possible. 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.

In both of the above cases, HIV drug treatment should continue during labor and delivery. Women with viral loads of 400 or more should receive intravenous (IV) administration of Retrovir, regardless of her HIV drug regimen during pregnancy or her mode of delivery. Women with a viral load of less than 400 can continue the regimen taken during pregnancy.

After delivery, the baby should receive liquid Retrovir for six weeks. 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 HIV treatment.

For HIV+ Women Already Taking HIV Drugs

Continue 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. If a woman is taking Sustiva when she learns she is pregnant, she may continue on Sustiva. This recommendation is based on the fact that Sustiva’s potentially harmful effects to the developing baby occur in the first five to six weeks of pregnancy, and most women do not find out they are pregnant before four to six weeks of pregnancy. Unnecessary switching of HIV drugs can increase the risk of passing HIV to the developing baby and contribute to loss of viral control.

If a viral load test shows that the drugs are not working, switch to a more effective combination. Retrovir should be used as one of the drugs in the combination if possible. The drugs should be continued during labor and delivery, during which time IV Retrovir should be given to the mother if she has a viral load of 400 or more. Women with a viral load of less than 400 can continue to take their current regimen. After delivery, the baby should receive liquid Retrovir for 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 infecting her baby by using HIV drugs during labor and delivery and to treat the baby for a short time after birth. The guidelines recommend the following:

  • IV Retrovir for the mother during labor and a combination of six weeks of Retrovir plus three doses of Viramune (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 HIV+ Women Who Have Not Taken HIV Drugs Before or During Labor

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

  • A combination of six weeks of Retrovir plus three doses of Viramune (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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