HIV

INFORMATION FOR WOMEN WHO HAVE HIV INFECTION DURING PREGNANCY OR BREASTFEEDING

The information provided below is for readers based in the United States of America. Readers outside of the United States of America should seek the information from local sources.

What is HIV infection?

Human immunodeficiency virus (HIV) is a disease-causing virus that suppresses the human immune system by attacking particular white blood cells (WBC) called CD4 lymphocytes. The suppression of immunity typically takes several years from the time of infection, but if the infection is not treated, the suppression reaches an advanced stage called acquired immunodeficiency syndrome (AIDS), which is characterized by extreme susceptibility to potentially fatal infections.

HIV is categorized into two subtypes: HIV-1 and HIV-2. HIV-1 occurs throughout the world and is the most common subtype in North America, whereas HIV-2 affects people mostly in West Africa. All types of HIV are retroviruses, which means that the viral genes can become incorporated into the DNA of cells that the virus infects, making it very challenging to fight the infection. In terms of the severity of disease, HIV infection is classified as stage 0, 1, 2, or 3, with stage 0 being an early infection, stage 3 corresponding to AIDS, and stages 1 and 2 being intermediate phases defined based on the number of CD4 lymphocytes present in each microliter of the persons blood (called the CD4 count).

In cases of pregnant women with HIV infection, the management goals are to prevent AIDS in the mother and also to prevent the virus from infecting the developing baby or newborn. While the stages are defined based on the CD4 count, a very important factor in protecting the developing baby is called the viral load, which refers to the amount of HIV virus in a particular volume of the mothers blood or other body fluids.

How common is HIV infection during pregnancy?

About 90.6 women per 100,000 are infected with HIV in the United States and its dependent areas. African Americans are affected more than other groups. HIV infection is most common in people of ages 25-29 years, and second-most common in those ages 20 – 24 years, but AIDS is more common in the 30 34 year age group (followed by the 45-49 year age group).

How is HIV infection diagnosed?

HIV is diagnosed with various blood tests. In some countries and communities, pregnant women are screened routinely, while in other areas they are tested only if they are considered to be at high risk for contracting HIV if there is a history of infections raising suspicion that they could be infected with HIV, or their jobs put them at risk (for instance working in health care environment). The first type of blood test is called an enzyme-linked immunosorbent assay (ELISA). This test is useful as a screening tool and is the first test performed because it is quick, fairly inexpensive, and has an extremely low rate of false-negative results. This means that the test is unlikely to miss a person who has been infected with HIV, so if your ELISA comes out negative, you really are negative for the virus. You can have a false-positive result, however, meaning that factors other than HIV in your blood can make the test come out positive. For this reason, anyone whose ELISA test comes out positive then has her blood tested again with a different HIV test called a Western blot. This test is more complex and more expensive but is more specific for HIV infection compared with the ELISA test. If this too is positive, then HIV infection is likely and many more tests are conducted. These tests include HIV RNA by polymerase chain reaction (PCR), a CD4 count, testing of the genetics of the HIV strain that you carry, basic blood tests, tests of urine samples, tests for hepatitis B and C viruses, tests for cytomegalovirus (CMV), human papillomavirus (HPV), and varicella-zoster virus, tests for tuberculosis and parasites, and tests for several sexually-transmitted infections.

Does HIV cause problems during pregnancy?

Its possible to be asymptomatic (feel no effects) for up to several years after being infected with HIV, but if you reach a high stage, where the immune system is suppressed (AIDS), you will suffer numerous infections, many of which are life-threatening.

Does HIV during pregnancy cause problems for the baby?

The viral load the amount of viral particles in a given volume of the mothers blood increases as the mother progresses from stage 0 to stage 3. The higher the viral load, the more likely it is that the virus will infect the baby. For mothers-to-be who are HIV-positive without having AIDS, the rate of infection to the baby is about 2 percent, but this risk can be decreased through the use of anti-HIV medications.

What to consider about taking medications when you are pregnant or breastfeeding:

  • The risks to yourself and your baby if you do not treat the HIV. These risks are significant.
  • The risks and benefits of each medication you use when you are pregnant
  • The risks and benefits of each medication you use when you are breastfeeding

What should I know about using medication to treat my HIV during pregnancy?

HIV infection is treated with a combination of medications, generally four different drugs that attack the HIV virus in different ways. This can sound scary for a mother-to-be, but when everything is considered, the risk of not taking medications is many times worse for you and the baby, compared with the risk from the medications. HIV medications are categorized based on their mechanism of action. One category of drugs, called reverse transcriptase inhibitors (RTIs) blocks an enzyme from the virus that allows it to make DNA from a similar molecule called RNA that it carries as its genetic material. RTIs are further categorized as nucleoside RTIs and non-nucleoside RTIs. Another category of drugs is called protease inhibitors. If a patient is merely exposed to HIV, but her tests show that an infection is not developing in her, she can be put on a single drug as a preventive measure against HIV infection and monitored frequently with blood tests to see whether or not the infection develops. When an infection has indeed developed, patients are put onto a regimen of multiple drugs, consisting of both subtypes of RTI and also a protease inhibitor. With very aggressive drug treatment and monitoring, its possible to keep an HIV infection in check for decades so that the person does not develop AIDS.

Most of the drugs available for combination therapy are considered relatively safe for the developing baby, meaning that the risk of not using them is higher than the risk of using them. There is one particular HIV drug thats avoided in pregnancy because there is some concern about possible bad effects on the baby, but different drugs can be switched in and out of the combination regime. The main controversy about HIV medications during pregnancy is whether they should be given during the first trimester or delayed until later in the pregnancy.

Who should NOT stop taking medication for HIV during pregnancy?

If you have an HIV infection, you absolutely need to take the drug therapy for most of the pregnancy, but the timing of that medication can be decided based on the viral load in your blood.

What should I know about choosing a medication for my HIV during pregnancy?

You may find Pregistrys expert reports about the individual medications used to treat HIV here.
Additional information can also be found in the sources listed at the end of this report.

What should I know about taking a medication for my HIV when I am breastfeeding?

Women with an HIV infection should not breastfeed, as there is a risk of infecting your baby. Instead, you should seek counseling on the proper use of infant formulas.

What alternative therapies besides medications can I use to treat HIV during pregnancy?

Once you have an HIV infection, there is no viable alternative to medication. The risk of infection to the newborn can be reduced by delivering through a cesarean section, instead of vaginally. However, the level of risk and the need for cesarean section depends on the viral load in your blood.

What can I do for myself and my baby when I have HIV during pregnancy?

Cooperate with your physicians, agree to combination drug therapy and measures that can reduce the risk to the newborn, such as cesarean section.

Resources for HIV in pregnancy:

For more information about HIV during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or check the following links:

 

Read the whole report
General information

It is very common for women to worry about having a miscarriage or giving birth to a child with a birth defect while they are pregnant. Many decisions that women make about their health during pregnancy are made with these concerns in mind.

For many women these concerns are very real. As many as 1 in 5 pregnancies end in a miscarriage, and 1 in 33 babies are born with a birth defect. These rates are considered the background population risk, which means they do not take into consideration anything about the health of the mom, the medications she is taking, or the family history of the mom or the baby’s dad. A number of different things can increase these risks, including taking certain medications during pregnancy.

It is known that most medications, including over-the-counter medications, taken during pregnancy do get passed on to the baby. Fortunately, most medicines are not harmful to the baby and can be safely taken during pregnancy. But there are some that are known to be harmful to a baby’s normal development and growth, especially when they are taken during certain times of the pregnancy. Because of this, it is important to talk with your doctor or midwife about any medications you are taking, ideally before you even try to get pregnant.

If a doctor other than the one caring for your pregnancy recommends that you start a new medicine while you are pregnant, it is important that you let them know you are pregnant.

If you do need to take a new medication while pregnant, it is important to discuss the possible risks the medicine may pose on your pregnancy with your doctor or midwife. They can help you understand the benefits and the risks of taking the medicine.

Ultimately, the decision to start, stop, or change medications during pregnancy is up to you to make, along with input from your doctor or midwife. If you do take medications during pregnancy, be sure to keep track of all the medications you are taking.


Medications for HIV


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