Can a 34-year-old woman with HIV safely get pregnant?

Question

Hello doctor,

I am 34 and have been HIV (human immunodeficiency virus) positive for six years. I have been on antiretroviral therapy, and my viral load has been undetectable for the past two years. My husband and I want to have a baby now, but I am scared about transmitting HIV to the baby. My CD4 (cluster of differentiation) count is 580, which my infectious disease doctor says is good, but I am still worried.

I have been taking Tenofovir, Emtricitabine, and Efavirenz daily without missing any doses. Since starting the medications, my periods have become irregular, and I sometimes experience spotting between cycles. The fertility specialist wants to do IVF (in vitro fertilization) with sperm washing, but I am confused about all these procedures.

I am also experiencing some vaginal dryness and recurrent bacterial vaginosis, which keeps coming back despite treatment. My gynecologist says it is common in people with HIV, but it is affecting my relationship. My questions to you are

What are the safest options for conception when someone has HIV?
Which medications are considered safe during pregnancy?
Will my HIV medications harm the baby if I get pregnant?

Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I have gone through your query and understand your concern.

The leading cause is the immunocompromised state due to HIV, which can lead to recurrent infections like bacterial vaginosis and candidiasis.

IVF (in-vitro fertilization) is the best option. In IVF, the best sperm and the best egg are selected, so the chances of the baby being abnormal or the embryo being defective are significantly reduced.
With advancements in science, some medications are safe to use during the first trimester of pregnancy. Again, with IVF, we can make the necessary drug changes while planning the pregnancy itself.
With HIV (human immunodeficiency virus), there is a higher chance of repeated infections. You need to maintain proper personal hygiene, wear cotton underwear, use pantyliners, use condoms, and take appropriate medication. Drinking plenty of fluids and taking probiotics also helps.
Due to the immunocompromised state, periods may become irregular, which can make natural conception time-consuming and not advisable in your case.
IVF is not scary. It is a well-structured and timed procedure that allows us to monitor every stage of the baby's development.
For vaginal dryness, I suggest using water-based lubricants.

I recommend doing a Pap smear and a pelvic ultrasound. You should take the following medicines:

Tablet Itraconazole 200 mg, to be taken twice daily for seven days.
Clingen vaginal pessary, one tablet to be inserted at bedtime for seven days.
Take Tablet Levocetirizine 10 mg at bedtime for seven days to help with itching or discomfort.

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.