Many women with HIV now experience pregnancy and have a child (or children) who does not have HIV.
Expert understanding of strategies to prevent transmission of HIV means the great majority of babies born to HIV-positive women in Australia are born without HIV infection.
Antenatal care and HIV treatment
HIV generally does not affect pregnancy and pregnancy does not make HIV progress any faster. Being pregnant will not affect your viral load. Your CD4 count may drop, however, this drop is usually temporary. Your CD4 count will generally return to pre-pregnancy level soon after the baby is born. A drop in CD4 will become a concern if your CD4 count falls below 200 because you will be at risk of opportunistic infections, so additional medications may be needed.
Use of antiretroviral drugs is recommended for all HIV-positive pregnant women regardless of viral load. The decision whether to take antiretroviral treatments remains yours but it is important to know that reducing your viral load to the lowest possible level (ideally to an undetectable level) dramatically reduces the likelihood of your baby getting HIV. In fact, an HIV-positive woman’s viral load is the single most important factor determining her baby’s risk of HIV infection. Having a low viral load will also improve your immune status throughout your pregnancy.
Be aware that whether or not you take HIV antiretroviral treatments during your pregnancy and delivery, you will be required to have your baby treated with antiretroviral therapies for a period of six weeks after delivery to improve his or her chance of being HIV negative (see PEP). In addition, it is still recommended that all women with HIV in Australia do not breast feed.
Your doctor should follow Australian Guidelines and closely monitor you for any treatment side-effects during pregnancy, particularly because some side-effects are more common in pregnant women.
Your doctor should also regularly check for opportunistic infections as part of your ongoing HIV care if you have a very low CD4 count. Treatment and prevention for most opportunistic infections during pregnancy is similar to that for non-pregnant adults. Only a few drugs are not recommended.
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, preventative treatment for herpes with Acyclovir is often recommended during pregnancy. Prevention and treatment of tuberculosis (TB) infections is also recommended if necessary during pregnancy. There are specific guidelines about treating HIV during pregnancy that your doctor will follow.
Various pre-natal genetic tests are available to screen for abnormalities. Tests include ultrasound screening, chorionic villus sampling and amniocentesis. Some of these tests (e.g. amniocentesis) are invasive so they increase risk of HIV transmission from you to your baby, and therefore are not performed on women with HIV. You can discuss this issue in more detail with your Obstetrician.
HIV & Hepatitis
Hepatitis B: Hepatitis B infection can impact your pregnancy so it is important to be tested. It is possible to pass on hepatitis B to your baby, however, whether or not you have hepatitis B, the National Immunisation Program provides free hepatitis B vaccine to all infants shortly after birth. If you choose to have your baby immunised the birth dose will be given as soon as the baby is stable, preferably within 24 hours of birth and up to seven days of age.
Your baby will need three more doses of the hepatitis B vaccine to be fully immunised. These will be given at two, four and six months of age in combination with your baby’s other routine childhood immunisation so your baby will not receive any additional needles.
The hepatitis B vaccines used in Australia contain a genetically engineered part of the virus. It is not a live virus, so it is not possible to get hepatitis B from the vaccine.
Hepatitis C: Pregnancy does not affect hepatitis C progression unless you have cirrhosis of the liver.
Some Hep C treatments are not recommended during pregnancy as particular drugs (like Ribavirin) are associated with birth defects and foetal death. Talk through your Hep C treatment options with your doctor.
Conversely, if you have hepatitis C and are pregnant, HIV antiretroviral treatments are definitely recommended because HIV replication makes it more likely that you could transmit Hep C to your baby. Treating your HIV lessens the chance of both HIV and Hep C transmission. See Women and Hepatitis on the Hepatitis Australia website for more information.
Risk of Hep C transmission is increased during delivery if your waters break more than six hours before delivery (‘prolonged rupture of membranes’), which also increases the chance of HIV transmission. For this reason, pre-labour elective caesarean is often recommended. Any invasive monitoring procedures such as foetal scalp monitoring are also advised against.