HIV Positive And Pregnant

HIV Positive And Pregnant

For many women, having a child is part of their life plan. Provided that she receives prompt and appropriate medical management, an HIV-positive diagnosis doesn’t mean that a woman’s plans should change.

As it is for HIV-uninfected women, an HIV-infected woman is also able to live a long and relatively healthy life, including having a healthy pregnancy, a normal vaginal birth and a healthy, HIV uninfected baby.

Antiretroviral therapy, or ART, is a cocktail of three drugs used to manage HIV infection. In the pre-ART era the majority of HIV transmissions from mother to child occurred during the birthing process, where the baby was in contact with the mother’s blood and bodily fluids. In order to lessen the exposure to these HIV-infected fluids and thereby minimise the risk of HIV infection, HIVinfected
pregnant mothers were advised that a caesarean section was the safest way of giving birth. With ART the decision between elective caesarean section and normal vaginal delivery is much less straight forward.

For an otherwise healthy HIV-infected pregnant woman who’s considering elective caesarean solely on the basis of her HIV status, viral load should play an integral part in the decision-making process.

The viral load is a measure of the strength of the HIV in an infected person’s blood. Provided that ART is used as prescribed, within 12 weeks of initiating therapy, an HIVinfected person’s viral load
should be “undetectable”. This means that the virus has stopped replicating the blood is almost clean of the virus.

Unfortunately, the virus hides in certain sites within the body, so if the person stopped taking ART, the HIV would start replicating again and the viral load would again increase. Babies born through
normal vaginal delivery to moms with an undetectable HIV viral load should therefore have no greater risk of HIV transmission when compared to babies born by elective caesarean section.

It’s important to remember that while vaginal delivery is a normal physiological process, caesarean section is a major surgical procedure with a higher risk of complications ncluding death). In addition, a caesarean section necessitates a longer hospital stay, more frequent follow-up and higher risk of complications in subsequent pregnancies.

PREGNANCY, LABOUR AND DELIVERY
Department of Health HIV management guidelines stipulate that all HIV-infected pregnant women should be started on lifelong ART. Ideally, an HIV-infected woman should be on ART before falling pregnant.
This is the best situation as the baby will then have a very small risk of contracting the virus and mom will be as healthy as possible during the pregnancy. To further reduce the risk of HIV transmission to the baby, mom should ensure her partner uses a condom consistently during pregnancy
and that she presents for medical treatment as soon as possible if she falls ill.

In some countries Elective Caesarean Section is not offered to HIV-infected women based on their HIV status alone. HIV-infected women are advised to continue using their ART as normal during labour
and after delivery.

Delivery facility staff will also try to avoid procedures that may place the baby at additional risk
of HIV infection during the labour and delivery process (if at all possible they will avoid artificial rupture of membranes, invasive foetal monitoring techniques and routine suctioning of the baby after birth).

CARE OF THE HIV-EXPOSED INFANT
After the birth, babies exposed to HIV are offered HIV PCR testing. This type of HIV test is able to immediately detect infection in the baby so that baby can be initiated on ART as soon as possible. In the first years of life, HIV-exposed babies should receive HIV PCR testing again at 10 weeks of age and again six weeks after breastfeeding is stopped. HIVexposed babies should also be tested for HIV at 18 months of age.

If at any time baby becomes ill, it’s important for mom to disclose her HIV status to the healthcare worker – baby may need additional tests to rule out HIV infection. Provided the initial test is negative, baby will be given ART syrup (usually nevirapine syrup) to take daily for between 6 and 12 weeks after birth. Immunisation schedule and breastfeeding recommendations remain the same for both HIV-exposed and unexposed babies.

The Departments of Health have adopted a universal breastfeeding policy.
This means that all moms (irrespective of their HIV status) are advised to breastfeed their babies. An undetectable viral load affords an HIV-infected mom a greatly reduced chance of transmitting HIV to her baby through breastmilk.

The best way of deciding on the most appropriate birth plan for you is to be informed of the
advantages and disadvantages of each birthing method and how these are impacted on by HIV infection.
Talk to your healthcare provider for more information.

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