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.
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.
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.