HIV treatment during pregnancy

If you are not yet on HIV treatment, but need it for your own health, you will be advised to start as soon as possible, in the same way you would if you weren’t pregnant.

The situation will be a little different if you are not already on treatment and you don’t yet need it for your own health.

Your doctor will advise you to start taking anti-HIV drugs during the second trimester of the pregnancy (which is between weeks 13 and 28). It is recommended that you definitely start treatment by week 24 of your pregnancy. The higher your viral load, the earlier you will be advised to start taking treatment. If your viral load is over 100,000, you may be advised to start treatment before the second trimester starts.

You should continue taking the drugs for the rest of the pregnancy. Your healthcare team can help you with ways to make sure you take your drugs properly if you are not used to this.

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

Which drugs should you take?

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.

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.