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Factsheet 8. HIV treatment for pregnant women: HIV treatment, hepatitis and pregnancy

Selina Corkery
Published: 20 June 2013

BHIVA (the British HIV Association) is an organisation that represents healthcare professionals working in HIV in the UK. Its guidelines set out the medical and other care people living with HIV can expect to receive in the UK. You can find out more about the process used to develop the guidelines in: How BHIVA guidelines are developed.

BHIVA’s guidelines, Guidelines for the management of HIV infection in pregnant women 2012, set out evidence-based clinical practice for treating and managing HIV infection in women who are already pregnant. These guidelines also specify the treatment and care of the newborn baby in relation to preventing HIV transmission. HIV clinic staff, following recommendations in these guidelines, will be providing the best possible treatment and care to their patients, taking into account individuals' situations as well as what is known about the most effective treatments during pregnancy. If you also have hepatitis B or hepatitis C (often called co-infection), this will affect your treatment choices. Your doctor should discuss your treatment options with you.

This symbol identifies treatment or care that BHIVA suggests is appropriate: a recommendation with weaker evidence or some conditions attached.

GPP identifies a ‘good practice point’ – a recommendation drawn from everyday clinical experience rather than research-based evidence.

This factsheet summarises the recommendations relating to treatment during pregnancy and after your baby is born if you have HIV and hepatitis B or C co-infection.

There is information about BHIVA recommendations on the safest way for a baby to be delivered in Factsheet 6: HIV treatment for pregnant women: Mode of delivery, and about care and support before and after a baby is born in Factsheet 7: HIV treatment for pregnant women: Antenatal and postnatal care.

If you have been diagnosed with hepatitis B or hepatitis C

If you are pregnant, you should be vaccinated for hepatitis B after you have passed the first trimester of pregnancy (that is, after 13 weeks).

You can find out more about hepatitis B and hepatitis C on the NHS Choices website. For more information on co-infection with HIV and hepatitis B or hepatitis C, go to www.aidsmap.com or to the Co-infection Alliance website.

Liver function tests and other tests

  • have a viral load test to confirm the infection.
  • also be tested for other forms of hepatitis: A, B or C, and hepatitis delta.
  • have a range of liver function tests to see how well your liver is working and if there is any damage to it. This may include an ultrasound scan to look at the structure of your liver.
  • have a test to find out what type of hepatitis C you have (called a genotype).

All women should have their liver function tested regularly during pregnancy as a change in liver function can be an important indicator of several pregnancy-related health problems.

Women who are pregnant should not have their liver examined using a technique called FibroScan. If necessary, the health of your liver will be monitored using ultrasound scans.

Sometimes people starting HIV treatment develop symptoms from an illness they have had in the past. This is called immune reconstitution inflammatory syndrome (IRIS) and is actually a sign that the immune system is getting stronger. LFTs will be used to monitor whether liver disease from your hepatitis infection is getting temporarily worse (with more liver inflammation).

If you stop HIV treatment after your baby is born, it’s very important that your liver function continues to be monitored carefully.

Having your baby

If you are on HIV treatment and have an undetectable viral load, you can have a vaginal delivery, unless there are other medical reasons why you should not.

Treatment for hepatitis B

HIV treatment when you also have hepatitis B

The drug 3TC (lamivudine, Epivir) can be used instead of FTC, but FTC is the preferred option. It is available together with tenofovir in a pill called Truvada.

If your CD4 cell count is over 500, and hepatitis B is not causing liver damage that needs treatment, your doctor may suggest that you continue HIV treatment containing tenofovir and FTC after your baby is born.

If your CD4 cell count is over 500, but you have  hepatitis B virus present in your blood, or evidence of liver disease, you should stay on HIV treatment. Your treatment combination should include tenofovir and FTC.

If your hepatitis gets worse after you have stopped HIV treatment, you should start treatment again, taking a combination that works against both HIV and  hepatitis B (this should include tenofovir and FTC). You can also take the hepatitis B drug adefovir.

Hepatitis C treatment

Hepatitis C treatment currently includes the drug pegylated interferon, with or without another anti-hepatitis C drug, ribavirin.

You must not become pregnant while you are taking ribavirin, nor for for six months after finishing it, nor while your partner is taking ribavirin and for six months after he has finished it. The guidelines suggest using at least two forms of contraception during this period.

HIV treatment when you also have hepatitis C

As well as protecting your baby from HIV, effective HIV treatment reduces the risk of your baby being infected with hepatitis C.

If your CD4 cell count is over 500, and you don’t have hepatitis C virus present in your blood or evidence of liver disease, you can stop HIV treatment. Find out more about how this should be done in Factsheet 4: HIV treatment for adults: Stopping treatment.

If your CD4 cell count is over 500, but you have hepatitis C virus present in your blood, or evidence of liver disease, you should stay on HIV treatment.

If your CD4 cell count is between 350 and 500, and you don’t have hepatitis C virus present in your blood or evidence of liver disease, you can stay on HIV treatment if you would prefer to, as it can slow down damage to your liver.

BHIVA produces separate guidelines on how hepatitis B and hepatitis C should be managed in people who have HIV (other than during pregnancy). The current version is called Management of coinfection with HIV-1 and hepatitis B or C virus 2010. Updated guidelines will be published during 2013.

Factsheet 8. HIV treatment for pregnant women: HIV treatment, hepatitis and pregnancy

Published June 2013

Last reviewed June 2013

Next review September 2014

Contact NAM to find out more about the scientific research and information used to produce this factsheet.

HIV & pregnancy

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This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.