Can HIV-positive women conceive and have a safe pregnancy?

Question

Hello doctor,

I am a 24-year-old woman and I am trying to conceive. I am HIV positive and I would like to know if it is safe for me to get pregnant. I have an irregular menstrual cycle and am taking treatment. Can you explain to me the safety and precautions to take? Will my child also have HIV? In what ways can HIV be prevented in children? What are the major symptoms that I should be aware of? What other treatments can I take for HIV? Kindly suggest.

Answer 1

Hello,

Welcome to icliniq.com.

I am deeply concerned about your worries.

Yes, it is safe to have a pregnancy but if you follow the procedure that I am giving you.

Pre-conception care-

MDTA (multidisciplinary team advice) that includes an obstetrician, a physician expert in HIV, a psychiatrist, and a psychotherapist. You consult all of these doctors. From pre-conception till the first three months of pregnancy, take Folic acid 5 mg. You should get a CD4 (cluster of differentiation 4) count test, and it should be less than 50 cells/mm, and the viral load should be less than 200 copies/ml. You should continue taking anti-retroviral therapy (ART).

Antepartum care:

At booking, you should do an OGTT (oral glucose tolerance test) because ART (anti-retroviral therapy) causes diabetes in pregnancy. Fasting plasma glucose should be 5 mmol/l to 7 mmol/L. Plasma glucose level should be 4mmol/l up to 7 mmol/l. You should repeat the CD4 count and viral load every month. You should continue medication for HIV during pregnancy: ZVD, Lamivudine, and Nevirapine. You should repeat the OGTT at 24 to 28 weeks of pregnancy. You should get a dating scan between 11 and 13 weeks, an anomaly scan at 18 to 22 weeks, and a growth scan at 28 to 32 or 36 weeks. Also, repeat CD4 count and viral load at 36 weeks to decide the mode of delivery. If the CD4 level is less than 50 cells/mm, then we can do spontaneous vaginal delivery. When labor starts, we will start IV ZVD till delivery. If CD4 is more than 50 cells/mm, we will plan an elective cesarean section to avoid maternal-fetal risk of HIV transmission. We will start IV ZVD at the start of cesarean till cutting the umbilical cord

Post delivery:

We will give the baby a post-delivery prophylactic dose and do a blood test of the baby called cord blood. Then, we will repeat the test after three days. Then, we will do a PCR (polymerase chain reaction) test in the third week, third month, sixth month, and 18th month. Then we will shift the patient back to the HIV physician.

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I hope this information helps you.

Feel free to ask further queries.

Thank you.