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.
Set Up a Plan Early
“The best-case scenario is for the woman to begin speaking to her doctor or doctors about prenatal care even before she becomes pregnant,” Seidman says. “We want people to be on a good regimen prior to pregnancy, so we can talk about which drugs are safe to get on, and establish care as early as possible.”
Barring that, all pregnant women infected with HIV should be taking anti-HIV medications by the second trimester. Women diagnosed with HIV later in pregnancy should start taking anti-HIV medications as soon as possible.
But about 18% of all people with HIV don’t know their infection status. That means many women with HIV who become pregnant don’t know they have the virus.
Preventive Meds for Baby; No Breastfeeding
During labor and delivery, when the baby may be exposed to HIV in the mother’s genital fluids or blood, pregnant women infected with HIV get a steady drip of the antiretroviral drug AZT through a needle in their arm, while continuing to take their usual drugs by mouth.
Once they’re born, babies get liquid AZT in a syrup for 6 weeks as a preventive measure. The babies whose moms didn’t take anti-HIV meds during pregnancy may be given other anti-HIV medications along with AZT.
The final part of the care plan is to avoid breastfeeding, Seidman says, since breast milk is one of the primary body fluids through which HIV is passed.
“The combination of viral suppression, not breastfeeding, and giving the baby liquid ART after birth are the keys to having an HIV-negative baby,” she says.
