McMaster University

McMaster University

Early intervention will decrease baby's chance of acquiring HIV

The Hamilton Spectator
Dr. Sandra Seigel
December 6, 2012

Q: I am HIV positive and am pregnant with my first child. Is there anything that can decrease the chance that my baby will be HIV positive?

A: With current medications to treat human immunodeficiency virus (HIV), people are living longer and healthier lives. This includes women of child-bearing age. As a result, we are seeing more women who are HIV positive having children.

HIV can be transmitted from mother to child during pregnancy, at time of delivery and through breastfeeding. Without any intervention, the chance of a baby of an HIV positive mother being born HIV positive is 25 to 40 per cent. Fortunately, there are several interventions to decrease this chance.

The first thing you can do is take antiretroviral medications, which decrease the amount of HIV in your body. Not only do these medications improve your health, they also decrease the amount of virus that could cross over to your baby. If your virus is at an undetectable level on your blood tests, you can have a vaginal delivery since the risk of passing the virus on to your baby is very, very low. However, if your virus is not at this very low level a caesarean section may be recommended. An intravenous antiretroviral medication called zidovudine (AZT) can also be given during labour to further decrease the chance of your baby acquiring HIV. Your baby will be prescribed zidovudine (AZT) syrup twice a day for six weeks after birth.

If your virus is at an undetectable level at the time of delivery and your baby gets the six-week treatment with zidovudine, the chances of your baby being HIV positive is less than 1 per cent.

To further decrease the risk of transmission, formula is supplied free of charge to HIV positive mothers in Ontario for their infant’s first year of life to eliminate the risk of the baby acquiring HIV through breast milk.

To best care for yourself and your baby, the involvement of a clinic or service specializing in the care of people with HIV by a multidisciplinary team, including HIV physicians, nurses, social workers, pharmacists, pediatricians and dietitians, is crucial. A clinic can connect with an obstetrician with expertise in caring for HIV positive pregnant women to co-ordinate your care and support you during this important time.

After the baby is born the pediatrician will arrange HIV testing of your infant, and will follow your baby long-term to monitor for any effects as a result of the HIV medication, if prescribed.

It is recommended that all pregnant women be tested for HIV so the health of the mother and infant is optimized as early as possible.

The treatment of HIV positive pregnant women has been a success story. Today, there are many healthy infants born every year in Canada to HIV positive women. For more information, speak with your health care provider.

House Calls is written by experts at Hamilton Health Sciences. Dr. Sandra Seigel is a pediatrician with the Special Immunology Services (SIS) Clinic at McMaster University Medical Centre.

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