Having a baby when you are living with HIV

Key points

  • People living with HIV can give birth without passing on HIV to their baby.
  • Your options for conception will depend on your health and your partner’s HIV status.
  • Your doctor will recommend you start anti-HIV treatment during your pregnancy, if you are not already taking it.
  • Your viral load may affect some of your conception and birth delivery options.

People living with HIV can give birth to HIV-negative babies. Most of the advice for people with HIV is the same as it would be for anyone else thinking about having a baby. Some extra steps are necessary though to reduce the likelihood of HIV being passed on.

This page takes you through the things to consider when having a baby in the UK. From conception to infant feeding, it is important to keep your healthcare team informed so that you can receive specific advice that will work for you. 

When a person is taking HIV treatment, and they have an undetectable viral load, the risk of HIV being passed on to their baby is just 0.1% (or one in a thousand). Between 2012 and 2014 in the UK, only 0.3% of people with HIV (including people with a higher viral load) passed on HIV to their baby.

When thinking about conceiving, the advice will depend on each individual’s circumstances. Advice will be based on your general health; whether you are taking anti-HIV drugs; your viral load; and whether your partner has HIV.

If you are not already taking anti-HIV medication, you will be advised to do so. HIV can be passed on during pregnancy and birth; having an undetectable viral load will prevent this.

If you are planning on getting pregnant and are already taking anti-HIV medication, talking to your healthcare team will give you a clearer understanding about your current medication and if it is still the best option during pregnancy. In the UK, if your current anti-HIV medication is effective you will likely be advised to keep on taking it.

How can we conceive if one of us is HIV negative and one is living with HIV?

When a person living with HIV has an undetectable viral load, there is no risk of HIV transmission during sex. Providing the partner living with HIV has an undetectable viral load and neither of you have any sexually transmitted infections (STIs), sex without a condom is fine.

If you or your partner have a detectable viral load, it is important to discuss conception options that reduce or remove risk of transmission during sex to you/your partner and baby. Before deciding not to use condoms, get advice from your HIV healthcare team so that they can confirm what would work best for you. This may include the HIV-negative partner taking PrEP. PrEP reduces HIV transmission and is safe to take during pregnancy and breastfeeding.

Everyone planning a pregnancy – whether or not they have HIV – is advised to take a daily folic acid supplement whilst trying to conceive and for the first 12 weeks of pregnancy. Folic acid (vitamin B9) helps cells in the body to develop. It is difficult to get enough through diet alone.

HIV treatment during pregnancy

All pregnant people living with HIV are advised to start taking medication by week 24 of pregnancy, if they are not already. This is because an undetectable viral load prevents transmission during conception, pregnancy and birth.

Your birth plan

Glossary

undetectable viral load

A level of viral load that is too low to be picked up by the particular viral load test being used or below an agreed threshold (such as 50 copies/ml or 200 copies/ml). An undetectable viral load is the first goal of antiretroviral therapy.

viral load

Measurement of the amount of virus in a blood sample, reported as number of HIV RNA copies per milliliter of blood plasma. The VL is an important indicator of HIV progression and of how well treatment is working. 

 

caesarean section

Method of birth where the child is delivered through a cut made in the womb.

effectiveness

How well something works (in real life conditions). See also 'efficacy'.

pre-exposure prophylaxis (PrEP)

Antiretroviral drugs used by a person who does not have HIV to be taken before possible exposure to HIV in order to reduce the risk of acquiring HIV infection. PrEP may either be taken daily or according to an ‘event based’ or ‘on demand’ regimen. 

If you have an undetectable viral load at week 36 of pregnancy, the options for delivery are the same as anyone who does not have HIV. If there are no other considerations, then having a vaginal birth is an option for you. You will be advised to give birth in a facility that can provide the right tests and treatment for your child.

If your viral load is high (over 1000 copies), your doctor will likely recommend a planned caesarean delivery. A caesarean section (also known as a C-section) is an operation to deliver a baby that involves making a cut in a person’s stomach and womb. This prevents contact with blood and other fluids that a baby may come into contact with during a vaginal birth. A caesarean reduces the risk of passing on HIV.

Regardless of their viral load though, a person with HIV may have a caesarean for other medical reasons.

Medication for your baby

Your baby will need to take anti-HIV drugs for a period of time after birth. This will be in liquid form. This does not mean that your baby has HIV.

The length of time your baby will need to take medication will depend on your viral load. If you are undetectable throughout pregnancy, your baby will be giving medication for two weeks. If you are detectable, this may be extended to four weeks.

In the early years of your baby’s life, HIV tests will be done several times: just after birth; at six weeks; at 12 weeks; and at 18 months (final HIV antibody test).

If these tests are negative and you have never breastfed, you will know for sure that your baby does not have HIV.

Feeding your baby

In the UK (as with other high resourced countries) it is advised not to breastfeed your baby. The best way to ensure that HIV is not transmitted is to formula feed, as there is no risk of HIV being passed on.  

Although HIV is in an important factor to consider, it is not the only one. You may consider breastfeeding for other reasons. If you do consider breastfeeding, it is important that you have an undetectable viral load and stay in regular contact with your healthcare team. Before breastfeeding, it is important to discuss this with them. It is important that you stop breastfeeding if any of the following occur:

  • your HIV becomes detectable
  • you or your baby have tummy problems
  • your breasts and/or nipples show signs of infection (cracked, sore or bleeding nipples).

This will help to reduce HIV transmission during breastfeeding, but the most effective way to remove all risk is not to breastfeed.

From conception, to pregnancy, to delivery, to infant feeding, your journey will be unique to you. It is important that you get the best support and medical care for you and your baby. Staying in touch with your healthcare team will support you in achieving this.  

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