Treatment during pregnancy

Treatment during pregnancy

If you are in good health

If you have a good CD4 cell count and low viral load, and are not ill because of HIV infection, the UK guidelines recommend that you start taking AZT (zidovudine, Retrovir) in the final three months (the third trimester) of your pregnancy. You will also need to have an intravenous injection of AZT during delivery and to have a caesarean, rather than vaginal, delivery.

Another option is to take a short course of combination antiretroviral therapy during the last few months of pregnancy in order to get your viral load down to below 50 copies/ml. You may then have the option of a planned vaginal delivery.

Talk to your doctor or specialist midwife about your options so you can make an informed decision about the best mode of delivery for you.

If you are in good health at the beginning of your pregnancy, but become ill because of HIV later in your pregnancy and have to start taking antiretroviral therapy, then the aim should be to reduce your viral load to an undetectable level. You should continue to take HIV treatment after your baby has been delivered.

Your baby will receive treatment with AZT syrup for four weeks after it is born.

If you have a high viral load

If HIV has significantly damaged your immune system, or if you have a high viral load, then you are advised to start HIV treatment. This will include two drugs from the nucleoside reverse transcriptase inhibitor class (NRTIs), ideally AZT and 3TC (lamivudine, Epivir), and either the non-nucleoside reverse transcriptase inhibitor (NNRTI) nevirapine (Viramune) or a protease inhibitor. You can find out more about the classes of drugs in NAM’s Anti-HIV drugs booklet in this information series.

The higher your viral load, the earlier during your pregnancy you will need to start taking treatment. If you still have a detectable viral load before giving birth, then you need to have a caesarean delivery, but if your viral load is below 50 copies/ml and there are no apparent problems with the pregnancy, you may be able to have a planned vaginal birth.

Your baby will receive treatment with AZT syrup for four weeks after it is born.

If you are already on treatment

If you become pregnant whilst taking effective HIV treatment, you are recommended to continue taking this treatment.

Your baby will receive treatment with antiretroviral syrup (usually AZT) for four weeks after it is born.

If you become pregnant whilst on HIV treatment and your anti-HIV drugs are not suppressing your viral load to an undetectable level, then you should have a resistance test to determine your best drug options and then change to these drugs. The aim should be to get your viral load undetectable by the time you deliver.

Your baby will receive treatment with an antiretroviral syrup (to which your virus is not resistant) for four weeks after it is born.

If you are diagnosed late in pregnancy

If you are diagnosed with HIV late in your pregnancy (32 weeks or later), then you will need to start taking HIV treatment immediately. A blood test will be used to determine any resistance you have to anti-HIV drugs. The most common drugs used in this situation are AZT, 3TC and nevirapine, as these drugs are able to rapidly pass over the placenta into your baby’s body.

Your baby will usually receive treatment with the same combination of three drugs (AZT, 3TC, and nevirapine) as syrups for four weeks after it is born.

If you are diagnosed during delivery or afterwards

If you are diagnosed HIV-positive just before or during delivery, you will usually be given a dose of AZT by injection and oral doses of 3TC and nevirapine. Your baby will also need to take a triple combination of anti-HIV drugs for four weeks.

If you are diagnosed just after delivery, you won’t receive any anti-HIV drugs, but your baby will need to take a triple combination of anti-HIV drugs for four weeks.