My sister is pregnant with HIV. How to prevent its transmission?

Hello,

Welcome to icliniq.com.

I understand your concern.

I am so sorry your family is going through this. An HIV (human immunodeficiency virus) diagnosis during pregnancy is overwhelming enough on its own, and adding fear for the baby, worry about her older child, and concerns about stigma makes it even heavier.

The most important thing to hold onto right now is that with modern treatment, the outlook for both your sister and her baby is very good.

A viral load of 85,000 and a CD4 (cluster of differentiation 4) count of 310 absolutely warrant starting treatment right away, and the combination of Bictegravir, Tenofovir, and Emtricitabine is a powerful and commonly used regimen in pregnancy.

The goal is to get her viral load to undetectable as quickly as possible, ideally well before delivery.

When a pregnant person with HIV takes antiretroviral therapy consistently and achieves an undetectable viral load, the risk of mother-to-child transmission during pregnancy and delivery drops to less than one percent, often quoted around 0.1 to 0.5 percent in well-managed cases.

That is a dramatic reduction compared to untreated HIV, where transmission risk can be 15 to 40 percent. So medication adherence is the single most important factor in protecting the baby.

The nausea and headaches are, unfortunately, common early side effects of antiretroviral therapy, and pregnancy itself can worsen nausea.

She should tell her infectious disease doctor and obstetrician right away. They can prescribe anti-nausea medication that is safe in pregnancy, adjust the timing of the dose, recommend taking it with food or at bedtime, or, in some cases, switch to a different regimen if side effects are severe.

It is very important that she not stop the medication without medical guidance, because consistent daily dosing is what drives the viral load down.

Often, these side effects improve after the first few weeks as the body adjusts. Regarding breastfeeding, HIV can be transmitted through breast milk.

The risk is much higher when the viral load is detectable. When a person has a sustained undetectable viral load on treatment, the risk through breastfeeding is greatly reduced but not zero.

In your country and other high-resource settings where a safe formula is available, guidelines generally recommend avoiding breastfeeding to eliminate transmission risk.

Since she stopped breastfeeding her two-year-old last month, the risk to that child depends on whether she was viremic at the time.

Because she was not on treatment and did not know her status, there is a possibility of exposure, but it does not mean the child is infected. Her pediatrician should be informed so that appropriate HIV testing can be done.

Many children in this situation test negative, especially if maternal viral levels were not extremely high. Try not to jump to worst-case conclusions before testing is completed. Her current partner testing negative is reassuring.

PrEP (pre-exposure prophylaxis) for him is a very good preventive strategy and can reduce his risk of acquiring HIV by more than 90 percent when taken consistently.

If her viral load becomes undetectable and remains so, the risk of sexual transmission becomes effectively negligible, a concept often summarized as undetectable equals untransmittable in sexual relationships.

As for her job, HIV is not spread through casual contact, saliva, or the type of interactions involved in routine dental assisting when standard infection control procedures are followed.

Healthcare workers with HIV can and do work safely. She is protected by medical privacy laws, and she is not required to disclose her status to coworkers.

The stigma is often more frightening than the medical reality. With treatment, people living with HIV can have near-normal life expectancy, healthy pregnancies, and healthy relationships.

Right now, the priorities are controlling her viral load, supporting her through side effects so she can stay on therapy, coordinating closely with her obstetric and infectious disease teams, and arranging testing for her older child.

It is completely normal for your family to feel devastated, but this diagnosis today is very different from what it was decades ago. With proper care, the chances are strongly in favor of her delivering an HIV negative baby and staying healthy for many years to come.

I hope this helps.

Thank you.