HIV, AIDS and Pregnancy

HIV, or the human immunodeficiency virus, is a virus that destroys a type of defense cell in the body.  These cells are part of the body's immune system, the defense system that fights infectious diseases. As HIV destroys these defense cells, people with the virus begin to get serious infections that a healthy person can fight off — that is, they become immune deficient. The name for this condition is acquired immunodeficiency syndrome, commonly known as AIDS.Each year, thousands of people become infected with HIV.  HIV can be transmitted from an infected person to another person through blood, semen, vaginal fluids, and breast milk.The virus is usually spread through high-risk behaviors including:

• unprotected oral, vaginal, or anal sexual intercourse
• sharing needles, such as needles used to inject drugs and those used for tattooing.
• People who have another sexually transmitted disease, such as syphilis, genital herpes, chlamydia, gonorrhea, or bacterial vaginosis are at greater risk for getting HIV during sex with infected partners.

How HIV Affects Your Health

A healthy body is equipped with CD4 helper lymphocyte cells (CD4 cells). These cells help the immune system function normally and fight off certain kinds of infections. They do this by acting as messengers to other types of immune system cells, telling them to become active and fight against an invading germ.HIV attaches to these CD4 cells, infects them, and uses them as a place to multiply. In doing so, the virus destroys the ability of the infected cells to do their job in the immune system. The body then loses the ability to fight many infections.Because their immune systems are weakened, people who have AIDS are unable to fight off many infections, particularly tuberculosis and other kinds of otherwise rare infections such as pneumonia, meningitis, and encephalitis.  People who have AIDS tend to keep getting sicker, especially if they are not taking antiviral medications properly.Severe symptoms of HIV infection and AIDS may not appear for 10 years.  The amount of time it takes for symptoms of AIDS to appear varies from person to person. Some people may feel and look healthy for years while they are infected with HIV. It is still possible to infect others with HIV, even if the person with the virus has no symptoms at all. As the medical community learns more about how HIV works, they've been able to develop drugs to interfere with its growth. These drugs have been successful in slowing the progress of the disease, and people with the disease now live much longer.  But there is still no cure for HIV and AIDS.

HIV and Pregnancy

If a woman with HIV is pregnant, her newborn baby can catch the virus from her before birth, during the birthing process, or from breastfeeding.  If health care providers know that an expectant mother has HIV, they can take steps to prevent the spread of the virus from mother to baby.  If the mother does not receive treatment, 25 percent of babies born to women with HIV will be infected by the virus. With treatment that percentage can be reduced to less than 2 percent. Women who are planning on becoming pregnant or who are pregnant should be tested for HIV as soon as possible. The woman’s partner should also be tested.  The testing is conducted with a simple blood test.  Talk to your health care provider about your options regarding testing.  Additional information can be obtained from the National Center for Disease Control at http://www.hivtest.org.

If Your Test is Positive

In the majority of pregnancies, and if the mother is healthy in other aspects, the placenta helps provide protection for the developing infant.  Some things can reduce the protective ability of the placenta, including in-uterine infections, a recent HIV infection, advanced HIV infection or malnutrition. If you are HIV-positive, your healthcare provider may want to check you more often than usual. You may receive special counseling about a healthy diet with attention given to preventing iron or vitamin deficiencies and weight loss.  Also, you will be monitored for infections that might pose an extra hazard to you and your baby, such as urinary tract infections, tuberculosis or respiratory infections.

Drugs During Pregnancy

An HIV-infected pregnant woman is usually treated with a combination of HIV-fighting drugs to help protect her health and to help prevent the infection from passing to the unborn baby. There are several combinations of drugs widely used to treat HIV infection.  Your health care providers will work with you to determine the best combination to treat the infection with the least risk to your baby. 

Labor and Birth

 If no preventative steps are taken, the risk of HIV transmission during childbirth is estimated to be 10-20%.  Once the membranes around the baby rupture, the risk increases by 2% every hour.  For this reason, your healthcare provider may advise that you schedule a cesarean delivery.  Cesarean deliveries performed before labor and before the rupture of membranes can significantly reduce the risk of exposing your baby to the virus.

The Newborn Baby

Once the baby is born, he or she will be tested several times for HIV.  Some babies test positive at birth, but then test negative by the time they are six months old.  If the mother took medications for HIV during her pregnancy, the baby will be treated with medication several times a day for the first six weeks of his or her life.To avoid the risk of passing the virus on to their babies, mothers who are HIV positive should not breastfeed their baby.  The physician/midwife can advise you about infant formulas available that will insure the baby gets all of the necessary nutrients. 

Remember

HIV is a serious health problem that can be managed but not cured.  If you are pregnant and HIV positive, you must work closely with your healthcare provider to minimize your baby’s risk of being infected.