Having a baby when you are living with HIV

HIV can be passed on during pregnancy and birth. However, the risk of passing on HIV to your baby during pregnancy or birth is zero if you have an undetectable viral load (less than 50 copies/ml) from the time that you get pregnant until after you give birth.

Most pregnant people living with HIV in the UK give birth to HIV-negative babies. Between 2017 and 2018 only 0.22% of people with HIV passed on HIV to their babies.

Lots of the advice for people with HIV is the same as it would be for anyone else thinking about having a baby. But some extra steps are needed to reduce the chances of HIV being passed on.

This page takes you through the things to consider when having a baby.

Planning a pregnancy if you’re living with HIV

When you’re thinking about getting pregnant, the advice you’re given will be based on:

• your general health
• whether you are taking anti-HIV medication
• your viral load
• whether your partner has HIV.

If you are not already taking anti-HIV medication, you will be advised to start.

If you are planning on getting pregnant and are already taking anti-HIV medication, talk to your healthcare team. They will help you understand if your current medication is still the best option while you’re pregnant.

In the UK, if your anti-HIV medication is working well for you, you’ll probably keep on taking it as normal during your pregnancy. Sometimes your doctor might recommend you switch to a different medication during pregnant. This could be because pregnancy affects how your body processes the medication or because there isn't enough research about its safety in pregnancy.

Feeling and being sick (morning sickness) is common in the first three months of pregnancy. If you are finding it difficult taking HIV treatment because of this, talk to your healthcare team.

Everyone planning a pregnancy, whether or not they have HIV, is advised to take a daily folic acid supplement.

In the UK, the advice is to take 400 micrograms of folic acid every day while you are trying to get pregnant (conceive) and for the first 12 weeks of your pregnancy. This is because folic acid (vitamin B9) helps your baby’s brain and spine to develop normally. It is difficult to get enough folic acid through diet alone.

You may need to take a higher dose of folic acid if you or your partner has a history of certain medical conditions. Speak to your healthcare team about what dose of folic acid would be right for you.

Folic acid can affect how some other medications work. It’s important to tell your healthcare team if you want to start taking folic acid and you’re also taking a drug called cotrimoxazole (Septrin). This is because you may need to change how much cotrimoxazole you take.

Are HIV medications safe for my baby?

People are often advised to avoid taking medications if they’re pregnant, especially during the first three months. This is because some medications can affect the development of your baby.

However, the benefit of preventing HIV transmission to the baby outweighs any potential risks from using HIV treatment. Taking it is one of the most important things you can do for your baby. It also helps keep you healthy during your pregnancy.

You might have heard that some research linked an anti-HIV medication called dolutegravir with a slight increase in neural tube defects. However, more recent studies show that there is no increased risk.

Can I have a baby if my partner is HIV positive and I am HIV negative?

Yes, it’s possible to get pregnant in relationships where one person, or both people, has HIV. How to do this safely depends on viral load.

If a person living with HIV has a stable undetectable viral load, there is no risk of HIV being passed on to an HIV-negative partner during sex. This means that if neither of you have any sexually transmitted infections (STIs), you can safely have sex without a condom. If either of you do have an STI, this should be treated before you stop using condoms.

If you or your partner has a detectable viral load, it is important to discuss conception options that reduce or remove the risk of passing on HIV.

Before deciding not to use condoms, get advice from your HIV healthcare team. They can confirm what would work best for you. This may include the HIV-negative partner taking PrEP, which is a medication that reduces the risk of HIV transmission. PrEP is safe to take during pregnancy and breastfeeding.

Does HIV affect fertility?

There’s some evidence that people with HIV find it harder to become pregnant.

HIV can affect your body’s ability to produce the hormones oestrogen and progesterone. This can affect your fertility or lead to an early menopause, meaning you are unable to get pregnant, particularly if your CD4 cell counts are low.

If you are not pregnant after one year of trying, talk to your doctor for advice. If you’re over 36 years old, or you know you might have fertility issues, you should speak your doctor sooner.

Some people need to have fertility treatment to have a baby. This includes people who have difficulty getting pregnant, their partners, and also people in same-sex relationships.

Some types of fertility treatments use donated sperm or eggs. If you are living with HIV and you want to donate your eggs, sperm, or embryos, you can only do this if you have an undetectable viral load and you’re donating to your partner or someone else you know. You can't donate to someone you don’t know, for example, via a sperm bank.

The type of fertility treatments available to you for free via the NHS will depend on the area you live in. Speak to your doctor for more information.

What happens if I’m diagnosed with HIV while pregnant?

Being diagnosed with HIV whilst pregnant can be very upsetting, and coming to terms with your diagnosis may take time. Knowing your status means you have done one of the most important things to prevent HIV from being passed on to your baby.

You will be advised to start taking medication as soon as possible. If you do, it is likely that you will give birth to a baby without HIV.

Can HIV cause problems in pregnancy?

Untreated HIV can cause problems during pregnancy, such as giving birth early (prematurely), having a small baby, or having a stillbirth. But taking anti-HIV medication reduces the risk of these problems.

Many people have complications during their pregnancy whether or not they have HIV. These can be very difficult to deal with for both parents. Support is available from organisations in the UK such as Tommy’s, The Miscarriage Association, SANDS, and 4M.

There’s more information on this on another page.

Can I give birth naturally if I have HIV?

If you have an undetectable viral load at week 36 of your pregnancy, your options for delivery are the same as someone who does not have HIV. If there are no other issues, then having a vaginal (natural) 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, such as a birth centre or obstetric centre.

Some women consider water births. There is not much evidence about the safety of water births for babies born to women with HIV, mainly because they are less common. But if you would like a water birth and have an undetectable viral load, you should be supported to do so.

If your viral load is high (over 400 copies) at 36 weeks, your doctor will probably 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 your stomach and womb.

A caesarean reduces the risk of passing on HIV. This is because it prevents your baby coming into contact with blood and other fluids which they would be exposed to during a vaginal birth.

You might also have a caesarean for other reasons, even if your viral load is undetectable.

What medication will be given to my baby?

Your baby will need to take anti-HIV medication for a period of time after they are born. This medication comes as a liquid.

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 usually be given medication for two weeks.

If you are detectable, this may be extended to four weeks.

When will my baby be tested for HIV?

In the early years of your baby’s life, they will be tested for HIV several times:

• just after birth (before leaving hospital)
• between four and six weeks old
• between 10 and 12 weeks old
• at 24 months old (this is the final HIV antibody test).

Your baby will also be tested at two weeks if there is a higher risk that HIV has been passed on.

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

If you are breastfeeding your baby will also be tested every month for the whole time you are breastfeeding.

Your baby will also be tested four and eight weeks after you finish breastfeeding. If you breastfeed for longer than two years, your baby should have their final antibody test at least eight weeks after you stop breastfeeding.

Can you breastfeed with HIV?

The best way to ensure that HIV is not passed on is to formula feed. This is because even if you have an undetectable viral load, the risk of passing on HIV through breastfeeding is reduced, but not zero.

However, although HIV is an important factor to consider, it is not the only one.

You may consider breastfeeding for other reasons. If your viral load is undetectable and you agree to additional tests for you and your baby, you should be supported to breastfeed if you choose to do so. Talk to your HIV clinic before you start breastfeeding.

It is important that you stop breastfeeding if any of the following things happen:

• your HIV becomes detectable.
• you have trouble taking your anti-HIV medication.
• you or your baby has tummy problems such as feeling sick, being sick, or diarrhoea.
• your baby has any mouth problems, such as ulcers or thrush.
• you have any problems with your breasts, such as cracked, sore or bleeding nipples, mastitis, or thrush.

This will help to reduce the risk of HIV being passed on during breastfeeding.

If you don’t breastfeed, you might be able to access free formula milk for your baby. Your HIV clinic should be able to give you more information about this. 

You can read more about infant feeding choices on another page.