(Last updated 4/30/2014; last reviewed 4/30/2014)
The goal of HIV care during pregnancy is to protect the health of HIV-infected women and their babies. All pregnant women with HIV should take HIV medicines to reduce the risk of mother-to-child transmission of HIV and to protect their own health. (Currently, HIV medicines are recommended for everyone infected with HIV.)
Mother-to-child transmission of HIV is the spread of HIV from a woman to her child during pregnancy or childbirth (also called labor and delivery) or in breast milk. Mother-to-child transmission is the most common way that children become infected with HIV.
HIV medicines work in several ways to prevent mother-to-child transmission of HIV. HIV medicines reduce the amount of HIV in an HIV-infected pregnant woman’s body, which reduces the chances that her baby will be exposed to HIV during pregnancy and childbirth. HIV medicine also passes from a pregnant woman to her baby across the placenta (also called the afterbirth). This transfer of HIV medicine protects the baby from infection with HIV, especially near delivery when exposure to HIV in the mother's blood and other fluids is greatest. After birth, babies born to HIV-infected women receive HIV medicines to protect against infection from any HIV that passed from mother to child during childbirth.
Pregnant women with HIV can safely use many HIV medicines during pregnancy. However, during pregnancy, it may be necessary to change the dose of some HIV medicines. Health care providers consider the following factors when recommending HIV medicines for use in pregnancy:
It depends on a woman’s individual situation. The following information provides general guidance on when to start HIV medicines during pregnancy and what HIV medicines to use. The information is based on guidelines from the U.S. Department of Health and Human Services.
Women who are already taking HIV medicines when they become pregnant
Some women with HIV may be taking HIV medicines for their own health before they become pregnant. They should continue taking HIV medicines throughout their pregnancies. The HIV medicines will protect the women’s health and also prevent mother-to-child transmission of HIV.
A woman’s HIV regimen may change during pregnancy. For example, it may be necessary to change the dose of an HIV medicine because pregnancy affects how the body processes medicine. Pregnancy may increase the risk of certain side effects from HIV medicines. A change in HIV medicines may be necessary, but women should always talk to their health care providers before making any changes.
Pregnant women with HIV who are not yet taking HIV medicines
Some women with HIV may not be taking HIV medicines when they become pregnant. For these women, when to start taking HIV medicines during pregnancy depends on several factors.
Women who have a low CD4 cell count or symptoms of HIV infection should start HIV medicines as soon as possible in pregnancy.
These women should begin to take HIV medicines as early as possible in pregnancy to protect their health and to prevent mother-to-child transmission of HIV. Treatment with HIV medicines is recommended for everyone with HIV, but the recommendation is strongest for those who have a CD4 count less than 350 cells/mm3; symptoms of HIV disease; high HIV viral loads; or certain conditions, such as AIDS or certain HIV-related illnesses and coinfections. HIV-infected women in these circumstances should start taking HIV medicines as soon as possible in pregnancy.
In women who have a high CD4 cell count and no symptoms of HIV, there is less urgency to start HIV medicines as soon as possible in pregnancy. These women may consider waiting until after the first trimester of pregnancy (12 weeks of pregnancy) to begin taking HIV medicines to prevent mother-to-child transmission of HIV. To make this decision, women and their health care providers consider a woman’s CD4 count and HIV viral load, any pregnancy-related conditions such as nausea and vomiting, and the benefits versus the risks of waiting until after the first trimester of pregnancy to start HIV medicines to prevent mother-to-child transmission of HIV.
When recommending HIV medicines for use in pregnancy, health care providers follow the same guidelines used for women who are not pregnant. In addition, they consider what is known about the use of specific HIV medicines in pregnancy, including the risk of side effects that could harm a pregnant woman or her baby.
In general, the HIV regimen used in pregnancy should include two nucleoside reverse transcriptase inhibitors (NRTIs) plus a non-nucleoside reverse transcriptase inhibitor (NNRTI) or one or more protease inhibitors (PIs). To learn how each class of drugs works against HIV, read the AIDSinfo fact sheet on The HIV Life Cycle.
The regimen generally should include at least one of the following NRTIs that pass easily across the placenta:
During labor and delivery, women with HIV continue take their HIV medicines to reduce the risk of mother-to-child transmission of HIV. To learn more, read the AIDSinfo fact sheet on Preventing Mother-to-Child Transmission of HIV During Childbirth.
After birth, the babies of women with HIV also receive HIV medicines to prevent mother-to-child transmission of HIV. The HIV medicines protect the babies from any HIV that may have passed from mother to child during labor and delivery. To learn more, read the AIDSinfo fact sheet on Preventing Mother-to-Child Transmission After Birth.
Women discuss with their health care providers whether to continue taking HIV medicines after childbirth. When making this decision, they take into account the current recommendation that everyone infected with HIV take HIV medicines. HIV medicines prevent HIV from advancing to AIDS and reduce the risk of sexual transmission of HIV.