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FAQ: What do I need to know about pregnancy and HIV infection?

for Veterans and the Public

Frequently Asked Questions

If you are a woman living with HIV and you are pregnant or considering having children, congratulations! Medications to treat HIV have allowed women with HIV to live longer, healthier lives and given them the ability to deliver healthy, HIV-negative babies. Below, you'll find a list of common questions that women ask about pregnancy and HIV.

Q: I am a woman with HIV and am considering having children. Should I take HIV medicines?

Yes. In general, all HIV-positive persons should start antiretroviral therapy (also known as "ART") early, and as soon as they are ready. If you are a woman who is trying to get pregnant or plans to become pregnant soon, it is very important to start ART right away. These medications will help your body defend itself from HIV-related infections. Taking the medications every day and achieving an undetectable HIV viral load will also protect your partners from getting HIV. And, very importantly, taking ART every day will greatly lower your baby's exposure to HIV.

Women with HIV should try to achieve an undetectable viral load before they become pregnant. If an HIV-positive woman chooses not to take HIV medicines, the chance of the baby being born with HIV is 1 out of 4. But with effective treatment and an undetectable viral load, the chance of a baby being born with HIV is only 1 out of 1,000, or less!

Q: As a pregnant woman with HIV, what HIV medicines should I be taking?

It is very important to see a clinician who has experience in treating pregnant women with HIV. Most HIV medicines that are used for non-pregnant women can also be used for pregnant women, but some should be avoided or dosed differently in pregnancy.

When you and your doctor choose your HIV medicines, the decision will be based on many factors. These include whether your HIV virus has resistance to any of the medications, which ones you've taken in the past, what side effects you or your baby may experience during pregnancy and after birth, and how easy it will be for you to take the medicines every day.

Depending on these and other considerations, you and your clinician may choose to use a regimen that has been studied or used many times in other HIV-positive pregnant women. Or you may choose to use a newer regimen that has not been studied as well in pregnancy but is easy to take and works well against your HIV virus.

Q: I am already taking HIV medicines and I want to get pregnant. Do I need to switch my medicines?

If your HIV medicines are working and you have an undetectable viral load, you don't usually need to switch when planning for a pregnancy. However, there are a few HIV medications that your clinician may want you to avoid because of possible effects on the fetus. If possible, discuss this with your clinician before you become pregnant.

A woman's body undergoes many changes during pregnancy. These changes can affect how her body reacts to HIV medications. During pregnancy, a woman's body sometimes becomes more efficient at removing HIV medicines from the bloodstream. Depending on the medicines you are taking, your clinician may have to adjust the dosages to ensure that you and the baby are getting a sufficient amount.

Q: I am a woman with HIV and I want to get pregnant. How do I protect my male partner from getting HIV?

Women living with HIV have several childbearing options that protect their partners from getting HIV. Reproduction techniques like self-insemination (which you can do at home quite easily), intra-uterine insemination, or in-vitro fertilization pose zero risk to an HIV-negative male partner who is trying to have children with an HIV-positive woman.

If you are taking HIV medications (ART) every day and your HIV viral load has been consistently "undetectable," there is very little risk of infecting your partner. Some couples rely on the woman's ART to prevent transmission to the HIV-negative male partner and have sex without condoms at the time of ovulation (only then). Other couples add PrEP (pre-exposure prophylaxis), a once-a-day pill for the HIV-negative male partner to give additional protection against HIV infection; as above, the couple has intercourse without condoms at peak fertility time (only then). This minimizes the risk of infecting the partner, though it does not mean there is absolutely no risk.

Please discuss these and other questions with your health care provider.

For more information, see this FAQ:
Can a couple in which one person is HIV positive conceive a baby without passing the virus to the uninfected partner?

Q: After my baby is born, will he or she have to take HIV medications?

When a pregnant woman with HIV infection takes effective ART (HIV medications) during her pregnancy, the chances of her baby getting HIV are extremely low. Even so, to reduce the risk even more, it is recommended that all infants who are born to mothers with HIV infection mothers take medications for a short time. If you took ART during your pregnancy and had an undetectable viral load, your baby will receive liquid zidovudine (AZT, Retrovir®) for 4-6 weeks. If you didn't have an undetectable viral load during pregnancy, your baby may need more medicine.

Q: Why can't I breastfeed my baby?

Many mothers look forward to breastfeeding their babies. However HIV can be passed through breast milk. If you breastfeed your child, you run the risk of your baby getting HIV. In the United States, infant formula is readily available. Therefore, it is recommended that mothers with HIV do not breastfeed their babies and that they use formula instead. In developing countries, formula can be very expensive or difficult to obtain, so the benefits of breastfeeding outweigh the risks. If you would like more information on the possible risks and benefits of breastfeeding, consult with a pediatrician or obstetrician who is an expert in HIV infection, ideally before delivery.