(Last updated 11/14/2016; last reviewed 11/14/2016)
Yes. All pregnant women with HIV should take HIV medicines during pregnancy to prevent mother-to-child transmission of HIV. The HIV medicines will also protect the women’s health.
HIV medicines work by preventing HIV from multiplying, which reduces the amount of HIV in the body (viral load). A low viral load during pregnancy reduces the chances that any HIV will pass from mother to child during pregnancy and childbirth. Having less HIV in the body also helps keep the mother-to-be healthy.
Most HIV medicines are safe to use during pregnancy. In general, HIV medicines don’t increase the risk of birth defects.
When recommending HIV medicines for pregnant women with HIV, health care providers carefully consider the benefits and risks of specific HIV medicines.
All pregnant women with HIV should start taking HIV medicines as soon as possible during pregnancy. Women already taking HIV medicines when they become pregnant should continue taking the HIV medicines throughout their pregnancies.
The choice of an HIV regimen to use during pregnancy depends on several factors, including a woman’s current or past use of HIV medicines, other medical conditions she may have, and drug resistance testing. In general, pregnant women with HIV can use the same HIV regimens recommended for non-pregnant adults—unless the risk of any known side effects to a pregnant woman or her baby outweighs the benefit of a regimen. Also, the regimen must be able to control a woman’s HIV even with pregnancy-related changes that can affect how the body processes medicine.
In most cases, women already on an effective HIV regimen should continue on the same regimen throughout their pregnancies. But sometimes a woman’s HIV regimen may change during pregnancy. For example, a change in HIV medicines may be needed to avoid the increased risk of a side effect during pregnancy. Sometimes a woman, in consultation with her health care provider, may need to change the dose of an HIV medicine she is taking to offset pregnancy-related changes that make it harder for the body to absorb the medicine. But before making any changes to an HIV regimen, women should always talk to their health care providers.
Yes. The risk of mother-to-child transmission of HIV is greatest during a vaginal delivery when a baby passes through the birth canal and is exposed to any HIV in the mother's blood and other fluids. During childbirth, HIV medicines that pass from mother to baby across the placenta prevent mother-to-child transmission of HIV, especially near delivery.
Women who are already taking HIV medicines when they go into labor should continue taking their HIV medicines as much as possible during childbirth.
Women with a high viral load (more than 1,000 copies/mL) or an unknown viral load near the time of delivery should receive an HIV medicine called zidovudine (brand name: Retrovir) by intravenous (IV) injection. Women who did not take HIV medicines during their pregnancies should also receive IV zidovudine during childbirth.
Zidovudine passes easily from a pregnant woman to her unborn baby across the placenta. Once in a baby’s system, zidovudine protects the baby from any HIV that passed from mother to child during childbirth. For this reason, the use of zidovudine during childbirth prevents mother-to-child transmission of HIV even in women with high viral loads near the time of delivery.
Yes, a scheduled cesarean delivery (sometimes called a C-section) can reduce the risk of mother-to-child transmission of HIV in women who have a high viral load (more than 1,000 copies/mL) or an unknown viral load near the time of delivery. A cesarean delivery to reduce the risk of mother-to-child transmission of HIV is scheduled for the 38th week of pregnancy, 2 weeks before a woman’s expected due date.
It’s unclear whether a scheduled C-section can reduce the risk of mother-to-child transmission of HIV in pregnant women with a viral load of less than 1,000 copies/mL. Of course, regardless of her viral load, a woman with HIV may have a C-section for other medical reasons.
All decisions regarding the use of HIV medicines during childbirth and the choice of a scheduled C-section to prevent mother-to-child transmission of HIV are made jointly by a woman and her health care providers.
Prenatal care for women with HIV includes counseling on the benefits of continuing HIV medicines after childbirth. Life-long use of HIV medicines prevents HIV from advancing to AIDS and reduces the risk of transmission of HIV. Together with their health care providers, women with HIV make decisions about continuing or changing their HIV medicines after childbirth.
In general, babies born to HIV-infected women receive zidovudine for 4 to 6 weeks after birth. The HIV medicine protects the babies from infection from any HIV that may have passed from mother to child during childbirth. To learn more, read the AIDSinfo fact sheet on Preventing Mother-to-Child Transmission of HIV After Birth.
From the Department of Health and Human Services: Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States: