Monday, July 29, 2013

Pregnancy and HIV

I have received a lot of emails from both women and men who have HIV here in the Philippines and who are living in other countries, who feel that their dreams of having a family has been shuttered because of our incurable disease. Both husbands and wives are worried that they will pass the virus to both their partners and their babies during the process.

 Because of this I researched about it and I found some answers in the 100 Questions and Answers About HIV and AIDS, 2nd Ed., by Joel Gallant, MD, MPH. I will post both his number 76 and number 77 questions here,
1. What if I want to get pregnant?
2. How Can I father a child with an HIV-negative woman?

What if I want to get pregnant?
Pregnancy is a realistic option for HIV-positive women now that we can treat HIv effectively and prevent women from passing it to the baby. However, pregnancy should be carefully planned and closely monitored in HIV-poistive women.

 If you're not already on ART, don't need it urgently, and plan to get pregnant, you can consider waiting to start therapy until the second trimester. If you're already on ART, stay on it, but you may need to change your medications before trying to get pregnant.

 ART is a MUST after the first trimester since transmission to the baby is extremely unlikely if the mother has an undetectable viral load at delivery. The only antiretroviral drug known to cause birth defects is efavirenz (sustiva, atripla). Women should NOT get pregnant if they're taking efavirenz or have taken it within the last month. Nevirapine (Viramune) is safe, but only in women with CD4 counts below 250. Once on you're on nevi rapine, its safe to keep on taking it after the CD4 count increases. Most pregnant women take a protease inhibitor. The most widely used PI in pregnancy is lopinavir/ritonavir (Kaletra), but other PI's can also be used. We have tended to use to use zidovudine/lamivudine (Combivir) as the NRTI part of the regimen in pregnant women because of its safety record. However, zidovudine can cause nausea, already a common symptom during pregnancy, so other NRTI's can be considered. Elective caesarian section is sometimes used to further reduce the risk of transmission to the baby, but it's only necessary if the viral load is undetectable at the time of delivery.

 If your partner is HIV-negative, you should conceive using artificial insemination to avoid infecting him, especially if you're not on ART yet or have a detectable viral load. This can be done by a physician, or at home using the "turkey baster" approach, in which the partner's semen is squirted into the vagina using a turkey baster or syringe to avoid intercourse.

 HIV-positive women who want to get pregnant should talk first to their provider and to an obstetrician-gynecologist who has HIv expertise. there are so many issues to discuss besides ART, including safe conception, planning the delivery, breastfeeding, and medical care for the baby, just to name a few.

 How Can I Father a Child with an HIV-negative Woman?

 Conception is more complicated when the male partner is positive because of the risk of infecting the woman. Having an undetectable viral load on ART is the most important thing you can do to prevent transmission, though there's still a very small chance of infection, since men can have virus in their semen even when it's undetectable in their blood.

 Sperm washing is a technique that involves separating sperm from semen to reduce the risk of transmission. To date there haven't been any reported cases of an HIV-negative woman becoming infected with this procedure, but sperm washing is only done at a few medical centres and is very expensive.

 If you're going to conceive the "natural way", there are some things that can be done to reduce the risk. First, DON't attempt this until the man's viral load is undetectable. Second, try to conceive only during the most fertile part of the woman's cycle, using home ovulation tests. Finally, the woman can consider using pre-exposure prophylaxis (PrEP) before attempting conception. If you're contemplating this type of conception, get the advice of an expert first. It's also a good idea for both partners to be screened first for other sexually transmitted infections.

 If both partners are infected, this is less of an issue. The HIV status of the father is irrelevant as far as the baby goes since an infant can only be infected by its mother.

 Please check out these other blog entries:

 1. HIV+ Wants To Have a Family
2. Having Children Despite HIV
"WE ARE ALL IN THIS TOGETHER.
NO PLHIV is alone with his or her struggle with HIV!"

-Pozziepinoy-



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Credits: 
101 Questions and Answers About HIV and AIDS, 2nd ed. by Joel Gallant, MD,MPH