If you have a good CD4 cell count, low HIV viral load and are not ill because of HIV infection, UK guidelines recommend that you start taking AZT (zidovudine) in the final three months (third trimester) of your pregnancy. You will also need to take an intravenous injection of AZT during delivery and 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.
Your baby will receive treatment with AZT syrup for four weeks after it is born.
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 the HIV treatment after your baby has been delivered. Your baby will receive treatment with AZT syrup for four weeks after it is born.
If HIV has significantly damaged your immune system, or if you have a high viral load, then you are advised to take antiretroviral therapy, including 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 boosted protease inhibitor. 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 become pregnant whilst taking effective antiretroviral therapy, you are recommended to continue taking this treatment. You will need to have a special anomaly scan between weeks 18 and 20 of your pregnancy to check your baby’s development. Your baby will receive treatment with antiretroviral syrup (usually AZT) for four weeks after it is born.
If you become pregnant whilst taking antiretroviral therapy 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 anti-HIV drugs. The aim should be to get your viral load to an undetectable level by the time you deliver. You will need to have an anomaly scan between weeks 18 and 20. 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 with HIV very late during pregnancy (32 weeks or later), then you will need to start taking antiretroviral therapy immediately. A blood test will be used to determine any resistance you have to anti retroviral therapy. 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 HIV-positive during delivery, or just after, then 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.
Because of the risk of birth defects you should not take the anti-HIV drug efavirenz (Sustiva) during pregnancy or if you are thinking of becoming pregnant. However, research suggests that the risk of birth abnormalities associated with efavirenz therapy is no higher than the risk seen in the general population. If you are taking efavirenz and become pregnant you should talk to your doctor about your options.