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HIV and Pregnancy

By Suz Redfearn
WebMD Feature

HIV-positive women who are thinking about getting pregnant -- or already are pregnant -- have options that can help them stay healthy and protect their babies from becoming HIV-infected.

Since the mid-1990s, HIV testing and preventive measures have resulted in more than a 90% decline in the number of children in the U.S. infected with HIV in the womb. And after three decades of research, doctors now understand how to craft a detailed plan to keep babies of HIV-positive women from getting the virus.

Medications Are Key

HIV is passed from one person to another through blood, semen, genital fluids, and breast milk. Pregnancy, labor and delivery, and breastfeeding all pose a risk of passing HIV along to the baby.

Seble G. Kassaye, MD, an assistant professor of medicine at Georgetown University, says prevention starts with antiretroviral drugs. These medications were first approved in the 1990s, and researchers soon learned that combining three of them -- called an antiretroviral (ART) regimen -- added up to a lot of protection for a baby in the womb.

“With interventions that we now have -- which include starting women on well-tolerated antiretroviral medications as early as possible -- transmission risk can be reduced to less than 2%,” says Kassaye.

The drugs lower the amount of virus in the body, which lowers the risk of mother-to-child HIV transmission. Some anti-HIV medications also pass from the pregnant mother to her baby through the placenta. This helps protect the baby from HIV.

No Missed Doses

For all of this to work, the mom must commit to taking her ART regimen, which can sometimes be a challenge during pregnancy.

“The key to keeping the virus suppressed within your body and your baby’s body is taking your medicines every day,” says Dominika Seidman, MD. She's an obstetrician-gynecologist at San Francisco General Hospital with specialty training in HIV. “If the side effects are bothering you or you can’t keep the medicines down due to morning sickness, see your doctor right away. He or she can help you find a way to stay on them.”

Two Drugs to Avoid

Only two antiretroviral drugs have been shown to pose a danger to babies in the womb when taken in the early months of pregnancy. They are Sustiva and Atripla (which contains Sustiva).

About 25% of babies whose HIV-positive mothers don’t go on ART will contract HIV, says Kassaye.

The best plan, Seidman says, is for HIV-positive women to talk through all of their options with their doctor early on.

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