Can women with HIV deliver a healthy baby?

Question

Hi doctor,

My daughter is 26 years old and was diagnosed with HIV three months ago after routine prenatal testing when she found out she was pregnant. Her viral load at diagnosis was 45000 copies/ml, and CD4 count was 380 cells/mcl.

The infectious disease doctor started her on a tablet containing Bictegravir, Emtricitabine, and Tenofovir alafenamide right away, and now viral load is undetectable, which is good, but she has been dealing with so much emotionally.

She is 28 weeks pregnant now and terrified about transmitting HIV to the baby, even though doctors say the risk is very low with treatment. Her partner tested negative, thankfully, and is being supportive, but her mental health has really suffered.

She has been having terrible nausea from the HIV medications that make her pregnancy morning sickness even worse. She has also developed anemia with hemoglobin at 9.1 g/dL and has to take iron supplements.

Her gynecologist is planning a C-section delivery and says the baby will need AZT syrup after birth. The stigma is the hardest part, and she has not told anyone except her medical team about the HIV diagnosis. She is worried about breastfeeding because she really wanted to nurse, but doctors say formula feeding is safer.

She is also concerned about future pregnancies and whether she can have more children. Her liver enzymes were slightly elevated initially, with ALT at 67 U/L, but came down after a few weeks of treatment.

Will she need to be on HIV medications forever?
Can she live a normal lifespan with proper treatment?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

Thank you for sharing your concerns.

Yes, she can live a normal lifespan and have a healthy baby with proper treatment. Key points for this are:

Low transmission risk: With an undetectable viral load, the risk of passing HIV (human immunodeficiency virus) to the baby is extremely low (less than 1 %). The planned C-section (cesarean section) and baby's Zidovudine provide extra protection.
Medications are for life: Antiretroviral therapy (ART), like a tablet containing Bictegravir, Emtricitabine, and Tenofovir alafenamide, must continue forever to keep the virus suppressed. This is now a manageable chronic condition.
Future pregnancies: Absolutely possible. The goal is to maintain an undetectable viral load before and during pregnancy.
Breastfeeding: In Western countries, formula feeding is recommended to eliminate any risk of transmission. This is the safest choice.
Address side effects: Tell her doctor about the nausea; switching to a different single-tablet regimen may help.
Mental health: The stigma and anxiety are real. Connecting with a therapist or support group (online or in-person) is crucial.

Reassurance is that modern HIV treatment means she can have a normal life expectancy, a healthy family, and will not transmit HIV to her partner or future babies as long as she stays on her medications and remains undetectable.

I hope this answers your query.

Do not hesitate to reach out if your symptoms worsen or if you have any new concerns.

Thanks and regards.