Diagnosed while pregnant

Discovering that you are HIV positive while you are pregnant can be a shock. It’s important to know that taking anti-HIV drugs can dramatically reduce the risk of you passing on HIV to your baby.

The higher your viral load, the earlier you will be advised to start taking treatment.

If you don’t yet need anti-HIV drugs for your own health, your doctor will advise you to start taking them during the second trimester of the pregnancy (this is between weeks 13 and 28). It is recommended that you definitely start treatment by week 24 of your pregnancy.

If your health is good, with a high CD4 count and a low HIV viral load, and you are willing to have a caesarean section, you may take one drug only. This is called AZT.

Most women take a combination of three anti-HIV drugs, usually including AZT and 3TC. You will need to be on combination therapy, and have an undetectable viral load, if you would like to have a vaginal delivery.

You’ll be advised to start taking combination therapy immediately if you’re diagnosed late in pregnancy (after week 32). In this case, you may take a combination with a fourth drug, raltegravir.

You should continue taking the drugs for the rest of the pregnancy and for a while afterwards. Your healthcare team can help you with ways to make sure you take your drugs properly if you are not used to this, and with how to stop after the baby is born. If you need to be on treatment for your own health, you will need to continue taking treatment after your baby is born.

Research and experience suggest that anti-HIV drugs are safe to use in pregnancy. There may be a slightly increased risk of giving birth prematurely or having a low birth-weight baby. Also, some babies do get anaemia (a shortage of red blood cells) but this is temporary.

Delivery

You can reduce the risk of HIV transmission further by having a managed delivery. Your doctor will look at your viral load when you are 36 weeks pregnant and discuss options with you.

If you have an undetectable viral load, it is usually recommended you have a vaginal delivery. You will need to continue with your HIV treatment during labour.

If your viral load is detectable, but very low (under 400), your doctor will look at your particular situation and discuss options with you.

If your viral load is above 400, it is recommended you have a planned caesarean section.

If you find out you have HIV during delivery, or just after, then you should be given a dose of anti-HIV drug AZT (zidovudine, Retrovir) by injection and oral doses of AZT and nevirapine (Viramune). Your baby will also need to take a triple combination of anti-HIV drugs.

After the baby is born, you can talk to your doctor about whether you need to continue treatment or not.

Breastfeeding your baby is not recommended as HIV can be passed on in breast milk. Find out more about what happens after your baby is born.

Find out more about staying healthy during your pregnancy and increasing your chances of having a healthy, HIV negative child.

Support

If you are diagnosed with HIV while pregnant then you may need emotional support in coping with your diagnosis and information about transmission and treatments. Positively UK is a charity providing support to people living with HIV and can offer you friendly advice and support.