HIV, AIDS, and Pregnancy

What are HIV and AIDS?

HIV is the abbreviation used for the human immunodeficiency virus. HIV is the virus that causes AIDS (acquired immunodeficiency syndrome), a life-threatening disease.

HIV attacks the body's immune system. It destroys infection-fighting cells. When these cells are destroyed, the immune system can no longer defend the body against infections and cancers.

HIV infection becomes AIDS when you lose your ability to fight off serious infections or tumors. Various infections called opportunistic infections develop. They are called opportunistic because they take advantage of the weakened immune system. These infections would not normally cause severe or fatal health problems. However, when you have AIDS, the infections and tumors are serious and can be fatal.

If you are pregnant and you are infected with HIV, your baby may be infected by the virus before or during birth. The baby can also get the virus from your breast milk. Babies who are infected may become very sick and die.

Without treatment, about one third of babies born to HIV-infected mothers become infected with the virus. You should be tested for HIV before you become pregnant, and at an early prenatal visit. If you are infected with HIV, then treatment during the pregnancy can help prevent spread of the infection to your baby.

How does HIV infection occur?

You can become infected with HIV through:

• unprotected sexual activity
• shared needles
• contact with infected blood or semen
• transfusion with infected blood (now rare in the US because of current screening tests)

HIV can be passed to an unborn baby through the placenta, by exposure to blood and body fluids during labor and at delivery, or through breast-feeding.

What are the symptoms?

You can be infected with HIV and not have any symptoms. Or you may have one or more of the following signs and symptoms, such as:

• fever that lasts from a few days to longer than a month
• loss of appetite or weight, especially loss of more than 10% of body weight
• prolonged swelling of the lymph nodes
• sore throat
• long-lasting or multiple viral skin problems, such as herpes sores or plantar warts
• repeated, severe yeast infections in your mouth or vagina despite treatment
• chronic muscle and joint pain
• diarrhea, especially if it lasts longer than a month
• headache

How is HIV infection diagnosed?

Usually the first test, the ELISA test, is a blood test although in some hospitals and facilities a new test that involves swabbing the gums may be done. The ELISA test is done to see if you are infected with HIV. If this test is positive, another more specific blood test, usually the Western blot test, is done to confirm the results. If both tests are positive, you are infected with HIV. Tests can usually detect HIV infection within several weeks of exposure to the virus. HIV tests are always strictly confidential whether the results are positive or negative.

How is it treated?

The chances that HIV will spread to the baby are lower when it is diagnosed and treated earlier during pregnancy. If you are pregnant and have tested positively for HIV, your healthcare provider will probably prescribe the antiviral drug zidovudine (also called ZDV or AZT). Other HIV-fighting drugs may be prescribed as well. It is not likely that you or your baby will have significant side effects from the drug treatment and it may help prevent spread of the virus to the baby.

Having a cesarean section (C-section) instead of a vaginal delivery also reduces the risk of infecting the baby. The C-section should be planned before the due date to prevent labor and delivery and early rupture of the membranes. Taking the medicine and having a C-section reduces the risk to a 2% chance of passing on the infection.

You may need to be treated with medicine for opportunistic infections such as pneumonia, TB, a yeast infection, or toxoplasmosis. You may also need treatment for other diseases that are common in people with HIV, such as herpes, hepatitis, or syphilis.

During labor and delivery you do not need to be isolated. All hospital personnel use special precautions when they handle blood or other body fluids to prevent the spread of infections, including AIDS. If you are having a C-section, you will probably need antibiotics to help prevent your getting an infection during the surgery. Make sure that you tell all your healthcare providers that you are HIV positive.

Your baby will be treated with ZDV right away after delivery, and for at least the first 6 weeks of life to help prevent infection. You should not breast-feed your baby. Give formula to your baby instead of breast milk to help prevent spread of the virus to the baby.

How will I know if my baby has an HIV infection?

Your baby will be tested for HIV after birth. However, if you have HIV, some of your antibodies to HIV may be passed on to the baby. This can cause the test results to be not completely accurate. If your newborn's tests are negative, you cannot be sure that the child is not infected with HIV until many months later. You will need to have your baby tested again after several months.

What can be done to help prevent HIV infection during pregnancy?

Ask for counseling and testing if you are pregnant or plan to become pregnant and are in any of the following high-risk groups:

• intravenous (IV) drug abusers and other drug abusers, such as cocaine addicts
• sexual partners of HIV-infected men or men in high-risk groups (such as drug abusers or bisexual men)
• women who have lived for a long time in an area where a lot of people are infected with HIV or who have given birth in such an area (such as Haiti and east central Africa)
• prostitutes
• women with more than 1 sexual partner or whose sexual partner is sexually active outside the relationship (especially women who live in areas where there is a high occurrence of HIV infection)
• women given transfusions of blood or blood products in countries where the blood may not be rigorously tested
• women who have cancer of the cervix

Know your partner. Ask about your partner's sexual history and if your partner has ever used IV drugs. Do not share toothbrushes, razors, or other items that may be contaminated with body fluids.

It is recommended that all women be tested for HIV before they get pregnant.

If you know that you are infected with HIV, you should seriously consider the grief and high cost of having a baby infected with HIV. Try to avoid becoming pregnant. Follow safe sex practices, including the use of latex or polyurethane condoms, to prevent the spread of the infection to others.