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
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