PREGNANCY AND HIV AND/OR AIDS
It is very important to determine your HIV status before you decide to have a baby, or as soon as you know that you are pregnant. An HIV-positive test result may be traumatic, but the knowledge of your status is empowering. Protective measures can be taken timeously, for the health of the expectant mother and to help prevent mother-to-child transmission.
You must continue to use condoms during pregnancy to provide protection against other infections and further exposure to HIV.
A pregnant HIV-positive woman with a healthy immune system may start antiretroviral (ARV) treatment to reduce the possibility of mother-to-child transmission. The South African Department of Health recommends that the introduction of ARVs be delayed to late in the first trimester, i.e. until 10 to 12 weeks duration of pregnancy. The ARV treatment can commence for the remaining pregnancy term, taken at the same time every day. Please take note of the instruction of whether to take the medication with or before meals. Three or more drugs are taken together, in order to optimise treatment and reduce possible resistance that would result in treatment failure. Side effects are usually mild and only last for a short period.
To further reduce the possibility of mother-to-child transmission, an infusion of AZT (an antiretroviral drug) is given to the mother during birth. Thereafter, AZT is given orally to the baby for six weeks after birth. It is very important that the six-hourly dosage of AZT syrup be given daily, without missing any doses. The baby must be tested at six weeks to determine its HIV status. No invasive procedures such as amniocentesis should be performed on a pregnant HIV-positive woman.
Mother-to-child transmission may be further reduced by exclusive bottle- or breastfeeding. Exclusive breastfeeding refers to breast milk only, not other liquids and solids. It is the mother's choice. However, the general consensus amongst HIV case managers seems to be that exclusive bottle-feeding is the best possible way to prevent mother-to-child transmission.
The HIV Education Programme, Desmond Tutu HIV Foundation states: ‘The risk of HIV crossing the placenta during pregnancy is 5%, while the risk of HIV infecting the infant during labour and vaginal delivery is 15%. Without HIV prophylaxis with antiretroviral drugs the overall risk during pregnancy, labour and vaginal delivery is therefore 20%. There is an additional risk of 15% if the mother mixes breastfeeds (breast milk plus other liquids and solids) for two years. The total risk of mother-to-child transmission (MTCT) in these breast fed infants of mothers that did not take ARV prevention as described above, is therefore 35%.'
A CD4 cell is a white blood cell, which has an important role in the functioning of the immune system. As HIV destroys the CD4 cells, the immune system becomes less capable of protecting the body against infection.
Should the expectant mother test HIV-positive and her immune system be weak (her CD4 count is less than 200 cells/mm³, ARV treatment that is not detrimental to the unborn baby will be chosen. The expectant mother will remain on treatment for the duration of her pregnancy and after the birth of the baby.
The Department of Health recommends that an HIV-positive woman who is already on antiretroviral treatment when she falls pregnant continue the treatment, provided that it excludes drugs that are harmful to the baby. Should the current treatment include efavirenz, stop taking this drug immediately and change to a more suitable alternative.
Those using efavirenz must be extra careful, as it is classified as a drug which has a high potential for causing malformation of the unborn baby if taken during pregnancy.
Inform your doctor/pharmacist of any medication that you are taking, including prescribed, over-the-counter or herbal medication. The medication needs to be checked to ensure that it's safe to use during pregnancy and for interactions that may reduce the efficacy of the antiretroviral treatment.
In addition to treatment, the following factors will contribute to a healthy pregnancy:
- healthy lifestyle
- a diet rich in fresh fruit and vegetables
- a good vitamin supplement
- moderate exercise
- adequate rest
- ability to cope with stress.
We encourage you to disclose your HIV status to someone whom you trust, who is a good listener and who will be someone to lean on when things become too difficult to face.
Always remember that babies are a blessing and one of the best ways to take care of baby, is to take care of mom.
References
1. Department of Health: HIV Education Programme.
2. Desmond Tutu HIV Foundation. Pregnancy and HIV. South Africa.