Nlm.nih.gov. How do I know if I need treatment for my own health as an HIV positive woman?
There are two tests, the CD4 test and the viral load test, that can help you and your doctor decide whether you need treatment for your own HIV infection. The CD4 test tells you how much HIV has weakened your immune system. The viral load test tells you how much HIV is in your blood. A pregnant HIV positive woman with a low viral load is less likely to have an HIV positive baby than a woman with a high viral load. Viral load tests may not be available to all women because of the cost.
If you have a high CD4 count (exactly how high depends on your circumstances and which country you are in), this means that you still have a strong immune system. Your health care provider will probably suggest that you do not start taking drugs for your own HIV infection but will probably advise that you start taking drugs to prevent HIV transmission to your baby.
Is it really safe to take HIV drugs during pregnancy?
Pregnant women are often advised not to take any medications during their pregnancy, so it can seem strange that HIV positive women are advised to take ARVs when pregnant. However, thousands of women have taken HIV drugs during pregnancy without it causing harm to their babies, and it has resulted in many babies being born HIV negative who might otherwise have been infected.
It cannot be guaranteed that HIV drugs taken when a woman is pregnant will not harm her baby. If a woman is not already taking ARVs then as explained above she will probably be advised to wait until after the first trimester before starting treatment. There are specific recommendations and guidelines (see the sources at the end of the page), about certain antiretroviral drugs and which ones are more of a concern than others. The Antiretroviral Pregnancy Registry monitors the birth defects induced by ARVs.
What else can I do to prevent my baby becoming infected with HIV?
Is a pre labour caesarean section (PLCS) better than a natural vaginal delivery?
A caesarean section is an operation used to deliver a baby through its mother’s abdominal wall. When a mother is HIV positive it is done to protect the baby from direct contact with her blood and other bodily fluids.
Research suggests that with many women now taking ARV combination therapy during pregnancy, having a caesarean isn’t a significant factor in preventing the transmission of HIV from mother to baby. Unless you are ill with HIV or have a detectable viral load it usually won’t be recommended by your health care provider, as having a caesarean does itself have some risks for the woman. One exception to this is if you are taking AZT on its own, when a PLCS may still be recommended.
Should I breastfeed?
HIV is found in breast milk, and if you breastfeed there is a significant chance of passing HIV to your baby. So if you have access to safe breast milk substitutes (formula) then you are advised to not breastfeed.
If you live in a country where safe water isn’t available, the risk of life-threatening conditions from formula feeding may be higher than the risk from breastfeeding. Formula can also be too expensive to use regularly in some countries. If you are in this situation it is better to feed your baby breast milk alone.
Mixed feeding is when a baby is fed with breast milk and other liquids such as formula, glucose water, gripe water or traditional medicine. It is now thought that there is a higher risk of a baby becoming HIV positive from mixed feeding than exclusive formula feeding alone or breastfeeding. Mixed feeding may damage the lining of the baby’s stomach and intestines making it easier for HIV in breast milk to infect the baby but when taking ARVs to prevent mother to child transmission, the risk is reduced and is currently recommended by the WHO.