Testing Positive For Hiv During Pregnancy
HIV testing of women in early pregnancy is now routine in Australia. Testing should be done with your consent and is offered during your first set of antenatal tests.
If you receive a positive test result, be reassured that many people with HIV live a full and active life. The risk of HIV transmission to your child is very low, given appropriate treatment.
Support is available through:
- .
Getting Pregnant When You Are Hiv
If you want to conceive, are an HIV-positive woman with an HIV-negative male partner, you can choose artificial insemination. You can do this at home using your partners semen, rather than having unprotected sex.
To improve your chances of becoming pregnant through artificial insemination it is best to do it at the most fertile time in your menstrual cycle.
Learning about fertility awareness will help you to know when you are most likely to conceive.
Speak to your GP, HIV doctor, sexual health nurse, or fertility specialist.
Telling Health Professionals About Your Hiv Status
It is important to tell your doctor, obstetrician or midwife about your HIV status as early as you can .
Telling your health team, helps to talk through any concerns you may have and ensure you receive treatment before that suits your needs, and is safe throughout pregnancy and after your baby is born.
Also, if your medical team knows about your HIV status, they can take steps to minimise the risk of accidental transmission during any medical procedures.
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Paternal Hiv Infection And Transfer Of Hiv From Mother To Fetus
Studies on vertical transmission of HIV have not considered the possible influence of paternal HIV infection. Fetal infection could result from integration of HIV in the sperm, but evidence for this is still controversial. Integration of HIV may occur in only a few sperm or reduce their fertility, which would make direct transmission from the father rare. No birth of an HIV positive infant to an uninfected mother has been reported. Furthermore, the insemination of HIV negative women with the processed semen of their HIV positive partners has led to non-infected babies.
Paternal HIV infection could influence vertical transmission by other mechanisms. Infected men shed cell free HIV and cell associated HIV in their semen. Unprotected intercourse during pregnancy would result in an unknown quantity of infected semen being repeatedly deposited inside the vagina, putting babies who are delivered by the vaginal route at increased risk of infection. We investigated whether paternal HIV increase the risk of vertical transmission.
Questions To Ask Your Doctor
If you have been infected with HIV or are at risk of infection, you probably have some questions about the condition and how it can affect your baby.
You may find it helpful to jot down questions as they arisethat way, when you talk to your doctor, you can be sure that all of your concerns are addressed.
Here are some questions to get you started:
- Should I get tested for HIV?
- What can I do to prevent infection?
- Im infected. Is there any way to prevent passing it on to my baby?
- What steps can we take if my baby does get infected?
- Whats the long-term outlook for a baby with HIV?
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Sampling Technique And Procedures
Among all health facilities reporting to Addis Ababa city health bureau those who reported at least one HIV positive child born to mothers on PMCT program of HIV from 01 January, 2014 to 31 December, 2015 were selected purposively from Addis Ababa city health bureau annual reports. Accordingly, 22 health centers and four hospitals were included into the study.
Since, number of HIV positive children born to mothers on PMTCT program in government health facilities in Addis Ababa during the period from 01 January 2014 to 31 December 2015 were only 67 children, all of them who met the inclusion criteria were recruited into the study. Consequently, all the 44 HIV positive children with their mothers were considered as cases and for each case four controls with the nearest date of birth to the cases were recruited from the same health facilities as the cases .
Fig. 2
Sampling procedure for case control study on determinants of HIV infectionamong children born to mothers on PMTCT in Addis Ababa, 2017
Can I Breastfeed If I Am Hiv Positive
About 15% of newborns born to HIV-positive women will become infected if they breastfeed for 24 months or longer.The risk of transmission is dependent upon:
- Whether the mother breastfeeds exclusively
- The duration of breastfeeding
- The mothers breast health
- The mothers nutritional and immune status
The risk is greater if the mother becomes infected with HIV while she is breastfeeding.
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Managing Illness As A Parent
Although medical advances now allow people with HIV to live full, healthy lives, you may have times where you or your partner is unwell or needs medical care.
As with any longer-term illness, this can impact on your ability to earn an income, manage a household or raise children.
Living with chronic illness can be a challenge and sometimes families need extra support. Trying to sort things out on your own can make life seem overwhelming. Dont be afraid to ask for help from expert organisations that support people with HIV.
How Can Vertical Transmission Be Prevented
There is a set of effective strategies that prevent mother-to-child transmission from taking place. These are called PMTCT: prevention of mother-to-child transmission.
Many women living with HIV have given birth to HIV negative children by taking these precautions:
By doing these things, the chances of the baby having HIV become very low under 1%. If you’re on HIV treatment and have an undetectable viral load, the chances are lower still: 0.1%.
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Antenatal Care For Women Living With Hiv
You’re likely to be looked after by a team of healthcare workers during your pregnancy.
Youll still get your care at your HIV clinic. But, as well as your HIV doctor and clinic staff, youre likely to see an obstetrician , a specialist midwife and a paediatrician.
Other people you may see, depending on the kind of help youll need, could include:
- a peer support worker
- a psychologist
- a social worker or a patient advocate.
Theyll help you with issues like problems with housing, finances or alcohol and drug use. They can provide support and advice on your eligibility for free NHS treatment and other financial help, such as help with formula feeding.
Like all health professionals, the members of your antenatal care team are bound by confidentiality guidelines and will not disclose your status to anyone without your consent.
Frequency Of Perinatal Hiv Transmission
Without treatment, 25 to 30% of babies born to a mother living with HIV will get HIV. However, if mothers are aware of their HIV infection and treated along with their infants, the chances of the infant getting HIV are less than 2%.
In Minnesota, the rate of perinatal transmission decreased with the availability of testing and treatment for pregnant women and their babies. During 1982-1994 the transmission rate was 25%, but has since decreased to less than 1.9% among babies born in 2015-2017.
In the U.S., through December 31, 2015, 11,600 cases of perinatal transmission have been reported. In Minnesota, a total of 12 cases of perinatal transmission have been reported since 1999.
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How Is My Baby Tested For Hiv
Your baby will have a blood test for HIV within a few hours after birth. This test will be done again when your baby is 1 month old and again when your baby is about 4 to 6 months old.
If these three blood tests show no HIV in your baby’s blood, it is almost certain that your baby is not infected. However, one last HIV test has to be done when your baby is 18 months old. Until then, your doctor will look at your baby often for signs of HIV infection. If one HIV blood test is positive, your doctor will do the test again. Your baby might get some other tests to look for HIV infection.
How Can My Baby Get Hiv
Even if a mother has HIV infection but not AIDS, she can pass HIV to her baby during pregnancy, during labor, or after delivery. Most babies who get infected with HIV get the virus during labor.
If you have HIV infection, there is a 1 to 30 percent chance that you will pass HIV to your baby. The degree of risk depends on your own health and what you do to keep your baby from getting HIV.
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Preventing Perinatal Hiv Transmission
Perinatal transmission of HIV can almost always be prevented with proper medical care. All pregnant women should get tested for HIV and share the test results with their prenatal care provider. If a woman has not received prenatal care she should request a rapid HIV test at delivery. Providing the proper medication to pregnant people living with HIV and their newborn babies will cut the risk of transmitting HIV to the baby from 25% to 2% or less.
Hiv: How Its Not Transmitted
The following are nine ways the virus is not spread:
Kissing and touching. Social kissing and hugging pose no risk of transmission, Sha says. Also, being sexual with someone without exchanging infected body fluids does not spread the virus. The only time deep kissing is a risk is when the person infected with HIV has open sores or oral bleeding, Sha notes.
Sharing a living space. Any casual contact with someone who has HIV, including sharing a bathroom, is safe. However, Sha tells patients not to share razor blades or toothbrushes. If someone who is infected nicks himself while shaving or has bleeding gums, it could increase risk of transmission.
Sharing food or utensils. The virus cannot survive on surfaces, so sharing utensils and other household items will not spread HIV. You can even share a meal with someone who is infected without worry. Transmission has been associated with mothers pre-chewing food for their babies, when infected blood from the mouth mixes with the food. Known as pre-mastication, it is a common practice in Africa, but not typically done in the United States, Sha says.
Saliva, sweat, or tears. An infected persons saliva, sweat, and tears do not put you at risk.
Water fountains. Sipping from a water fountain after someone who has HIV used it is considered casual contact and will not lead to transmission.
Mosquitoes and other insects. The virus is not viable in insects or ticks, Sha says.
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What Choice Should I Make
You are the only person who should decide how your baby will be fed. If you choose to breastfeed, it is important to take your HIV drugs, and keep up with health care visits and viral load testing, exactly as prescribed and recommended by your provider. It is also very important to find a support network, including a providerand other allieswhom you trust, and who can be good sources for information without judgment.
Making this decision can be a challenging process. You may feel fear, stress, or even some sadness over any of the choices you are considering. It is also important to remember to take care of yourself during this process. It may be helpful to connect with a group of women or others who can offer support, to write about your thoughts and concerns, or to engage in some other activity that helps you feel supported as you prepare to make the best possible decision for you and your growing family.
Get Tested For Hiv As Soon As Possible To Know Your Status
- If you have HIV, the sooner you start treatment the betterfor your health and your babys health and to prevent transmitting HIV to your partner.
- If you dont have HIV, but you or your partner engage in behaviors that put you at risk for HIV, get tested again in your third trimester.
- You should also encourage your partner to get tested for HIV.
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Where To Get Help
- , Centers for Disease Control and Prevention.
- Palasanthiran P, Starr M, Jones C, Giles M 2014, Management of perinatal infections, Australasian Society for Infectious Diseases , Sydney.
- 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, 2017, Panel on treatment of HIV-infected pregnant women and prevention of perinatal transmission, AIDSinfo, USA.
- Antiretroviral drugs for treating pregnant woman and preventing HIV infection in infants Recommendations for a public health approach, 2010, World Health Organization.
- Perinatal exposure to HIV among children born in Australia, 19822006, Medical Journal of Australia, vol. 190, no. 8, pp. 416420.
- Perinatal exposure to HIV in Australia, 1982-1994, Medical Journal of Australia, vol. 166, no. 2, pp. 7780.
- Variable uptake of recommended interventions to reduce mother-to-child transmission of HIV in Australia, 1982-2005, Medical Journal of Australia, vol. 189, no. 3, pp. 151154.
- Lindsay, M 2014, Women with HIV infection on antiretroviral therapy with low viral loads can safely opt for vaginal delivery in the absence of obstetrical risk factors, Evidenced-Based Medicine, vol 19, no. 4, p. 159.
New York Public Health Law 2500
New York accounts for roughly one-fourth of the countrys pediatric HIV infections, with more than 87 percent of those infections in New York City . In the 1980s, New York was among a group of states that enacted blind newborn testing under the CDCs guidance. While names and test results were not connected, other demographic data from the mother were recorded and tracked. Blind newborn testing caused controversy because the practice released HIV-positive newborns to their mothers, who may or may not have known of their infants status, so there was not an opportunity to allow the newborns to receive treatment that may have prolonged their lives. This concern led New York to pass the AIDS Baby Bill .
As the commissioner of the New York State Health Department has explained, this essentially means that women in labor who were not tested during prenatal care will learn their HIV status during or immediately after delivery . The stated purposes of the regulations are to achieve the goal of universal prenatal counseling and testing, and to ensure that newborns who are born exposed to HIV receive prompt and immediate care and treatment that can enhance, prolong, and possibly save their lives .
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How Does Hiv Treatment Prevent Mother
Everyone with HIV is now recommended to start treatment at diagnosis whatever their CD4 count.
There are two different ways in which anti-HIV drugs act to prevent MTCT:
- They reduce your viral load so your baby is exposed to less HIV while in the womb and during birth. The aim of HIV treatment is to get, and keep, your viral load to undetectable levels.
- Some anti-HIV drugs cross the placenta and enter your babys body, preventing the virus from ever taking hold. Newborn babies are given a short course of anti-HIV drugs after theyre born when their mother is known to be HIV positive.
You can reduce the risk of HIV transmission further by having a managed delivery. Your doctor will look at your viral load when you are 36 weeks pregnant and discuss options with you.
What Role Do Hiv
Our studies of larger cohorts of motherinfant pairs near the time of transmission have suggested that neither the breadth of the maternal HIV-specific Nab response nor the breadth of the passively acquired HIV-specific Nabs in the infant correlated with risk of infant infection , . The caveat to these studies is that Nab activity was measured against representative HIV variants circulating in the population , not the individual autologous viruses from each motherinfant pair, as was done in some of the smaller studies. Thus, while the larger studies suggest limited benefit of broadly active Nabs in protection, these findings do not provide a definitive answer as to whether Nabs provide some protection against the specific HIV variants that the infant encounters. Studies using autologous virus are difficult to do on a large enough scale to convincingly address this complex question, but if this were undertaken, it would provide valuable information on the potential of HIV-specific Nabs to protect against HIV infection.
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Is It Safe To Take Hiv Medication In Pregnancy
Some medicines for HIV aren’t suitable to take during pregnancy.
If you have HIV and become pregnant, contact your local HIV clinic.
This is important because:
- some anti-HIV medicines can harm unborn babies, so your treatment plan will need to be reviewed
- additional medicines may be needed to prevent your baby getting HIV
But if you’re taking HIV medication and you become pregnant, do not stop taking your medication without first speaking to your GP.
Always check with your GP or midwife before taking any medicine when you’re pregnant.
These Factors Increase The Risk Of Passing Hiv On To The Baby:
- Being ill because of HIV, especially if you have tuberculosis .
- Having a high HIV viral load and a low CD4 cell count.
- Your waters breaking four hours before delivery, or earlier.
- Having an untreated sexually transmitted infection during pregnancy or at the time of delivery.
- Using recreational drugs, particularly injected drugs, during pregnancy.
- Having a vaginal delivery if your HIV viral load is detectable.
- Breastfeeding.
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