"LOVE SHOULDN'T KILL - HELP PREVENT AND CURE AIDS"

Special Issues for Women & Children

As with other illnesses, HIV disease is never the same in all people. HIV infection and the drugs to treat it can pose special challenges to both women and children. For instance, when HIV causes a woman's immune system to weaken, she can become susceptible to certain infections and illnesses that wouldn't be a risk for an HIV-positive man. And in very young children, their immune systems are still developing, so HIV disease and the strategies to treat it can be quite different from what we find in adults.

For an HIV - Positive woman who wants to have a baby, or is already pregnant, many questions arise.

What is the risk of transmitting HIV to your baby ?Are there treatments to lower this risk?Are anti-HIV drugs safe to take during pregnancy ?

Pregnancy & HIV
Is it Safe to be HIV + and Pregnant ?

Yes. Of course, as is the case with the rest of HIV and its treatment, they are no absolute certainties or across-the-board truths. Every woman is different.

However, there's no data suggesting that pregnancy accelerates the rate of HIV disease progression. HIV by itself won't stop you from having a safe pregnancy. If you're generally healthy, get good prenatal care, and are careful to avoid risk factors (smoking, high blood pressure, etc.), your chances of avoiding things like premature delivery and birth defects are not significantly different from those of your HIV-negative counterparts.

It can be hard to deal with the judgmental attitudes of people, including doctors, who think that it is morally wrong for HIV-positive women to get pregnant. The good news is that there are many strategies for dramatically reducing the risk of passing the virus to your infant – often referred to as perinatal or vertical transmission – which you and your doctor should be ready to discuss. If your health-care provider isn't supportive or is being judgmental, it's your right to find someone who will be supportive.

What Are the Risks of Transmitting HIV ?

An HIV - Positive pregnant woman – provided that she does not take any anti-HIV medications – has a 25% chance of passing HIV to her baby. However, if she takes anti-HIV drug therapy while she is pregnant, the risk of her passing the virus to her baby is much lower – in some cases as low as 2%.

How Does Transmission Work ?

Researchers are not exactly sure when babies are infected with HIV during pregnancy. It has been said that a small percentage of all babies are infected with HIV while developing inside their mothers' uteruses (wombs). However, this has not really been proven. It is known that the vast majority of infections occur during labor (the time of delivery) or after the baby is born and is breast-fed by his or her HIV - infected mother.

Throughout pregnancy, a developing fetus has his or her own blood supply. In other words, the developing fetus does not come into contact with the blood of his or her mother. This helps protect the fetus from infections in the mother's blood, such as HIV. However, developing fetuses do receive nutrients and various proteins, such as immune system antibodies, from their mothers. While a mother's HIV may not enter the fetus, her antibodies to the virus will. These antibodies cannot harm the fetus, but will cause the baby to test "positive" to an HIV antibodies test when he or she is born.

At the time of birth (labor), a baby often comes into contact with his or her mother's blood. If the mother's blood enters the baby's body, this is when HIV can be transmitted.

Don't All Babies Born to HIV-Infected Mothers Test Positive for the Virus ?

Yes, they do. It is important to keep in mind what the HIV test is. These tests look for antibodies to HIV, they do not look for the virus itself. Because a fetus is exposed to his or her mother's HIV antibodies, he or she will automatically test "positive" after birth. These antibodies can remain in the baby's body for more than 18 months after he or she is born.

Most hospitals now test babies born to HIV-infected women using "PCR". This test can be performed within a few days after delivery and looks for HIV itself in a blood sample collected from the baby. If the test is negative, it should be repeated within a few months after the birth to look for HIV.

Every pregnant woman, regardless of her HIV status, should see a doctor regularly to receive prenatal care. Simply put, prenatal care is a specialized type of health care designed to protect the health of both the woman and her developing baby. Prenatal care can help all pregnant women figure out what they should do to improve their diets and vitamin/mineral intake and to reduce unhealthy habits such as smoking, drinking alcohol, and doing drugs.

If a pregnant woman does not know whether or not she's HIV positive, most prenatal care programs now recommend HIV testing. While some states are hoping to make HIV testing a requirement for all pregnant women, no prenatal care program has the right to test a pregnant woman for HIV without her consent. In New York State, the law allows for any newborn baby to be tested for HIV, regardless of whether or not the baby's mother permits the test to be performed.

If a pregnant woman finds out that she is positive while she is pregnant, or knew that she was positive before getting pregnant, prenatal care programs can help protect her health and the health of her developing baby. Usually, a prenatal care program calls for monthly visits to a clinic or doctor's office for the first eight months of pregnancy. During the eighth and ninth months of pregnancy, visits are more frequent, typically every two weeks.

Prenatal care for women who are HIV infected may include T-cell counts and viral loads tests (see The Blood Tests You'll Need), treatments to prevent AIDS-related infections, anti-HIV drug therapy, management of drug side effects, and important nutritional care.

HIV-positive women might want to avoid some aspects of typical prenatal care. For example, amniocentesis, used to test for genetic defects in the baby, is done with a needle that passes through the mother's abdomen and into the womb. While this test may be necessary to look for any genetic problems that a developing baby may have, it can also increase the risk of transmitting HIV.

In the following sections, we'll discuss three topics that a pregnant woman should discuss with her doctor that can reduce the risk of transmission to her baby: anti-HIV drug therapy, Cesarean sections, and the risks of breast-feeding.

For pregnant women who are infected with HIV, the topic of anti-HIV drugs will most definitely come up as a part of a prenatal care program. These drugs, if taken correctly, can drastically reduce the amount of HIV in a mother's blood at the time of birth. This can help reduce the chances of passing the virus along.

Cesarean sections – an operation in which the baby is removed through an incision in the belly – reduces the amount of time the baby comes into contact with his or her mother's blood and has been shown to reduce the risk of transmitting HIV.

Since breast milk can also transmit HIV, formula feeding, whenever clean water and formula are available, is strongly recommended.

Only one anti-HIV drug – Retrovir (zidovudine; AZT) – has been approved by the U.S. Food and Drug Administration (FDA) for the prevention of mother-to-infant HIV transmission. According to a major study conducted several years ago about the National Institutes of Health, Retrovir therapy can reduce the risk of perinatal transmission from 25% to approximately 8%. While there are no guarantees that Retrovir therapy will prevent HIV from being transmitted from a mother to her baby, it greatly reduces the chance that transmission will occur.

Retrovir therapy during pregnancy is a three-part program :

A standard dose of the drug is started after the first trimester of pregnancy. In other words, an HIV-infected pregnant woman should take Retrovir for six months prior to giving birth to the baby. The dose is one 300 mg tablet taken twice a day.
At the time of delivery, whether it is by vaginal birth or C-section, higher doses of Retrovir are administered through an intravenous (IV) line.
A liquid form of Retrovir is given to the baby immediately after birth and continued for six weeks.

Pregnancy & HIV.

What About Anti-HIV Drug Therapy ?

Only one anti-HIV drug – Retrovir (zidovudine; AZT) – has been approved by the U.S. Food and Drug Administration (FDA) for the prevention of mother-to-infant HIV transmission. According to a major study conducted several years ago about the National Institutes of Health, Retrovir therapy can reduce the risk of perinatal transmission from 25% to approximately 8%. While there are no guarantees that Retrovir therapy will prevent HIV from being transmitted from a mother to her baby, it greatly reduces the chance that transmission will occur.

Retrovir therapy during pregnancy is a three-part program :

A standard dose of the drug is started after the first trimester of pregnancy. In other words, an HIV-infected pregnant woman should take Retrovir for six months prior to giving birth to the baby. The dose is one 300 mg tablet taken twice a day.

At the time of delivery, whether it is by vaginal birth or C-section, higher doses of Retrovir are administered through an intravenous (IV) line.

A liquid form of Retrovir is given to the baby immediately after birth and continued for six weeks.

Is This the Only Regimen Available ?

Researchers are still looking at other ways to use Retrovir to prevent mother-to-child transmission. For example, one study has already demonstrated that one dose of Retrovir given either to the mother during labor or to the newborn within 48 hours after birth, reduced the risk of transmission by more than half.

Results from another study suggest that giving a single dose of Viramune (nevirapine) to both mother and newborn infant reduces transmission rates by nearly 50%. This study was actually conducted in African women, many of whom do not receive adequate prenatal care. Nevirapine is current being studied in the United States and, if used in the setting of prenatal care or in combination with other anti-HIV drugs (e.g., Retrovir), the drug may prove to be very effective in reducing the risk of mother-to-child HIV transmission.

What About Combination Anti-HIV Therapy ?

More and more women are taking combinations of anti-HIV therapies to keep themselves healthier and alive longer. Effective combination therapy can lower viral load to below the limits of detection and ease the pressure on the immune system. Not only are the effects of combination therapy good for the mother, they have also been said to further reduce the risk of transmitting HIV.

Given what is known about Retrovir, it is recommended that any combination of drugs used during pregnancy include this drug.

Figuring out whether or not to start combination therapy – or remain on combination therapy – is a difficult decision for all HIV-infected pregnant women. If you are HIV-positive and pregnant, here are some questions you should consider discussing with your doctor before starting combination therapy:

How have you been feeling ?
What was your most recent T-cell count ?
What was your most recent viral load ?
Does your doctor think that you're at risk for developing HIV-related illnesses ?

Of course, HIV-infected pregnant women will want to consider how the drugs they're thinking of taking might affect the baby. There's new research being produce all the time about the safety and tolerability of different medications for pregnant women and their developing babies.