HIV and Women

The Use of HIV Medicines During Pregnancy

• Women who are already taking HIV medicines when they become pregnant should continue taking the medicines during pregnancy. Women with HIV who are not taking HIV medicines when they become pregnant should consider starting HIV medicines as soon as possible.
• Pregnant women with HIV can safely use many HIV medicines during pregnancy. Pregnant women and their health care providers carefully consider the benefits and the risks of specific HIV medicines when choosing an HIV regimen to use during pregnancy.
• Because pregnancy affects how the body processes medicine, the dose of an HIV medicine may change during pregnancy. But women should always talk to their health care providers before making any changes. 

The goal of HIV care during pregnancy is to protect the health of HIV-infected women and their babies. All pregnant women with HIV should take HIV medicines to reduce the risk of mother-to-child transmission of HIV. The HIV medicines will also protect the health of the pregnant women.

What is mother-to-child transmission of HIV?

Mother-to-child transmission of HIV is the spread of HIV from a woman to her child during pregnancy or childbirth (also called labor and delivery) or in breast milk. Mother-to-child transmission is the most common way that children become infected with HIV.

HIV medicines work in several ways to prevent mother-to-child transmission of HIV—both during pregnancy and after birth.
During pregnancy
The goal of HIV medicines is to reduce the amount of HIV in the body to an undetectable level (called an undetectable viral load) throughout a woman’s pregnancy. By reducing the amount of HIV in the body, HIV medicines reduce the chances that an HIV-infected woman will pass HIV to her baby during pregnancy and childbirth.
HIV medicine also passes from a pregnant woman to her baby across the placenta (also called the afterbirth). This transfer of HIV medicine prevents mother-to-child transmission of HIV, especially near delivery when a baby is most exposed to any HIV in the mother's blood and other fluids.
After birth
After birth, babies born to HIV-infected women receive HIV medicines to protect against infection from any HIV that passed from mother to child during childbirth.

Are HIV medicines safe to use during pregnancy?

Pregnant women with HIV can safely use many HIV medicines during pregnancy. Pregnant women and their health care providers carefully consider the benefits and the risks of specific HIV medicines when choosing an HIV regimen to use during pregnancy.
When recommending HIV medicines for use in pregnancy, health care providers consider the potential short- and long-term effects of HIV medicines on babies born to women with HIV. No HIV medicines have been clearly linked to birth defects, but some HIV medicines have raised concerns. Women who take HIV medicines during pregnancy are encouraged to enroll in the Antiretroviral Pregnancy Registry. The registry monitors prenatal (before birth) exposures to HIV medicines to detect any potential increase in the risk of drug-related birth defects. Pregnant women exposed to HIV medicines voluntarily enroll in the Registry through their health care providers.
Health care providers also consider the following factors when recommending HIV medicines to use during pregnancy:

• Pregnancy-related changes in the body that can affect how the body processes HIV medicines. Because of these changes, the dose of an HIV medicine may change during pregnancy. 
• The risk of certain side effects from HIV medicines during pregnancy.
• A woman’s medical history, including any past use of HIV medicines.
• Possible drug interactions between HIV medicines and other medicines a woman may be taking.
• Drug-resistance test results. Drug-resistance testing identifies which, if any, HIV medicines won’t be effective against a person’s HIV.
• A woman’s ability to take HIV medicines as instructed. 

When should a pregnant woman with HIV begin to take HIV medicines?

Some women with HIV may already be taking HIV medicines when they become pregnant. They should continue taking the HIV medicines throughout their pregnancies. The HIV medicines will continue to protect the women’s health and prevent mother-to-child transmission of HIV.

A woman’s HIV regimen may change during pregnancy. For example, some HIV medicines may not be recommended during pregnancy because of the increased risk of side effects. Because pregnancy affects how the body processes medicine, the dose of an HIV medicine may change. But women should always talk to their health care providers before making any changes.
Women with HIV who are not taking HIV medicines when they become pregnant should consider starting HIV medicines as soon as possible. HIV medicines reduce the amount of HIV in the body (HIV viral load). Having less HIV in the body reduces the risk of mother-to-child transmission of HIV and protects a woman’s health.  

What HIV medicines should an HIV-infected pregnant woman take?

When recommending HIV medicines for use in pregnancy, health care providers follow the same guidelines used for women who are not pregnant. They also consider what is known about the use of specific HIV medicines in pregnancy, including the risk of side effects that could harm a pregnant woman or her baby.

For women who have never taken HIV medicines, the preferred HIV regimen should include two nucleoside reverse transcriptase inhibitors (NRTIs) plus an integrase strand transfer inhibitor (INSTI), a non-nucleoside reverse transcriptase inhibitor (NNRTI), or a protease inhibitor (PI) with low-dose ritonavir (brand name: Norvir).

The regimen generally should include at least one of the following NRTIs that pass easily across the placenta:

• abacavir (brand name: Ziagen)
• emtricitabine (brand name: Emtriva)
• lamivudine (brand name: Epivir)
• tenofovir disoproxil fumarate (brand name: Viread)
• zidovudine (brand name: Retrovir)

Do women with HIV take HIV medicines during and after childbirth?

During childbirth, women with HIV take HIV medicines to reduce the risk of mother-to-child transmission of HIV. To learn more, read the AIDSinfo fact sheet on Preventing Mother-to-Child Transmission of HIV During Childbirth.

Babies born to women with HIV receive HIV medicines for 6 weeks after birth to prevent mother-to-child transmission of HIV. The HIV medicines protect the babies from any HIV that may have passed from mother to child during childbirth. To learn more, read the AIDSinfo fact sheet on Preventing Mother-to-Child Transmission of HIV After Birth.

Women discuss with their health care providers whether to continue taking HIV medicines after childbirth. HIV medicines are recommended for everyone infected with HIV. HIV medicines prevent HIV from advancing to AIDS and reduce the risk of sexual transmission of HIV.

This fact sheet is based on information from the following sources:

From the Department of Health and Human Services:

• Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States
• Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents: Initiating Antiretroviral Therapy in Treatment-Naive Patients