HIV infection

What is HIV and how is it usually transmitted?

HIV (Human Immunodeficiency Virus) is the virus that causes AIDS (Acquired Immunodeficiency Syndrome). This virus attacks our immune system making it difficult to fight off infections. HIV could be passed from one person to another by bodily fluids such as blood, semen, vaginal fluids and breast milk. It could not be passed by hugging or sitting next to the person. HIV is also known as a retrovirus. Hence, treatment for HIV is called as anti-retroviral drug. A combination of three or more anti-retroviral drugs are known as HAART. (Highly active anti-retroviral treatment)
What effect could HIV have to my unborn baby?
HIV could be transmitted to your baby via the placenta during pregnancy, during labor and breast feeding.
How could I reduce the risk of transmitting HIV to my baby?
  • Receive treatment for HIV i.e anti-retroviral drugs during pregnancy which may also promote your overall well-being.
  • Have a caesarean section instead of vaginal delivery.
  • Avoid breast feeding which reduces the risk of transmission by 2-fold.
The above steps will reduce the risk of transmission from mother to baby from 25% to less than 2%.
If I am HIV positive, what should I expect during my antenatal care?
  • You will be taken care by a group of healthcare professionals including a physician who specializes in HIV patients, an obstetrician, pediatrician, midwifes your general practitioner and social worker if required.
  • You may be advised to take anti-retroviral drugs during pregnancy and monitored for possible side effects.
  • You will be screened early in pregnancy and again at 28 weeks of pregnancy for other sexually transmitted diseases such as Hepatitis B or syphilis and vaginal infection. You would be treated appropriately if necessary.
  • Detail scan to detect any fetal anomalies especially if HAART is started less than 13 weeks of pregnancy.
  •  You may be advised to have an elective caesarean section at 38 weeks to reduce the risk of transmission to your baby.
  • Otherwise, you will be having similar antenatal check up like other pregnancy women.
What is the treatment for HIV during pregnancy?
Your doctor will advise you appropriately the best treatment for you during pregnancy.
  • If you do not require any anti-retroviral drug for yourself. Your doctor may offer you this treatment to reduce the risk of transmission to your baby at 28 – 32 weeks. The treatment could be zidovudine alone or HAART. (Highly active anti-retroviral treatment)
  • You are already on HAART. Your doctor will usually ask you to continue with these medications or review it’s the combination of medications at 13 weeks of pregnancy to see whether you need to change to other medications.
  • If you are diagnosed with HIV late in pregnancy and labor you will be started on HAART on continued during and after labor.
What are the possible side effects from HIV treatment?
Anti-retroviral drugs are generally safe. However, the possible side effects including:
  • Liver problems and rashes
  • Stomach and digestive problems
  • Breathlessness and fatigue
  • Diabetes
  • Reduce the levels of iron in your blood stream causing anemia.
  • High blood pressure during pregnancy may be higher in patients taking zidovudine.
What is the mode of delivery if I have HIV?
You should discuss this with your doctor as this depends on several factors. Your doctor may advise you for an elective caesarean section at 38 weeks of pregnancy if:
  • You are on zidovudine only.
  • You are not taking HAART.
  • If the virus could be detected in your blood.
What happens after delivery?
Your baby’s umbilical cord will be clamped as soon as possible. Then the baby is bathed and given anti-retroviral drug orally until he/she is about 4–6 weeks old. The pediatrician (baby’s doctor) will take care of your baby and follow up his/her development later on.
How do I know whether my baby has HIV or not?
A blood test to detect the virus will be done at birth, 3 and 6 months using the PCR test. If the baby is not breast fed, 99% of babies with negative PCR test will not have the HIV. However, the definitive test is the HIV antibody test. A negative result when the baby is 18 months of age confirms that your baby does not have HIV.
Management of HIV in pregnancy. Royal College Obstetricians and Gynaecologists UK. Guideline No. 39, April 2004.


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