Can a baby be born healthy if the mother is HIV positive?

Question

Hello doctor,

I am 31 years old and just found out I am HIV positive three weeks ago after routine prenatal testing. I am 16 weeks pregnant with my first baby and completely devastated. My CD4 count is 487, and my viral load came back at 45,000 copies, which the infectious disease doctor said needs treatment right away.

They started me on Biktarvy, but I am so scared about what this means for my baby and if the HIV will pass to him during delivery. My husband tested negative, which is confusing because we have been together for four years.

The obgyn wants to do a C-section and says I can not breastfeed, which breaks my heart because I really wanted that bonding experience. I am also having terrible morning sickness still, and the HIV medications make it even worse. I throw up almost every morning.

My family does not know yet, and I am terrified to tell them, especially my very religious parents. Can my baby be born healthy if I take the medications properly? Also, worried about how this will affect future pregnancies if we want more kids. What are the chances of transmission during delivery, even with treatment?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I can understand your concern.

Please know that with today’s medical advances, you can have a completely healthy baby and live a full, normal life, including having more children safely in the future. Let us go step-by-step so you understand everything clearly and feel more in control.

The good news is that the treatment works extremely well.

Biktarvy (Bictegravir, Emtricitabine, Tenofovir, and Alafenamide) is considered safe in pregnancy and highly effective at rapidly lowering viral load. The goal is to get your viral load to undetectable (<50 copies/mL) before delivery.
If you take your ART (antiretroviral therapy) daily and consistently, the risk of HIV (human immunodeficiency virus) passing to your baby can drop to less than one percent, nearly zero.

During pregnancy, with ongoing ART and regular follow-up, your viral load will likely become undetectable within eight to 12 weeks. You will have regular viral load monitoring every four to eight weeks to ensure the medicine is working.

Delivery and transmission risk: Mode of delivery depends mainly on your viral load, for example-

If undetectable (<1000 copies/mL), normal vaginal delivery is possible and considered safe.
If viral load remains >1000 copies/mL, elective C-section (before labor, before membrane rupture) is recommended to minimize transmission.

Mostly, breastfeeding is discouraged if safe formula feeding is possible, because HIV can pass through breast milk.

For future pregnancies, continue ART lifelong. If your viral load stays undetectable, conception is safe, and a natural pregnancy is possible.

Regarding follow-up: Any other pregnancy care, you can follow up with me.

I hope this helps.

Kindly follow up if you have more concerns.

Thank you.