People living with HIV can have healthy pregnancies, experience normal deliveries, and give birth to HIV-negative babies.[1]
Globally, around 1.3 million women living with HIV become pregnant every year. Without any preventative measures, there is a 15–45% chance of transmitting HIV to your baby (vertical transmission). This type of transmission of HIV can occur during pregnancy, labour, delivery, and breastfeeding.[2]
With effective HIV treatment and an undetectable viral load, the likelihood of vertical transmission is much lower.[3]
For example, between 2020 and 2021, only 0.36% of babies in the UK born to mothers living with HIV were HIV-positive as well. Where transmission had occurred, the mothers had either been diagnosed with HIV whilst pregnant or struggled to adhere to their treatment regimen.[4]
Pregnancy complications with HIV
There are some challenges a pregnant person living with HIV may face. Studies show that even with antiretroviral therapy (ART), women living with HIV may be two to three times more likely to experience pregnancy complications compared to women not living with HIV. These complications may include miscarriage, stillbirth, and low birth weight. However, it is unclear whether these complications are a result of HIV itself or ART.[5]
Additionally, pregnant women living with HIV who are not on ART are more likely to develop opportunistic infections; these are infections that occur more often or are more severe in people with weakened immune systems.[1,6] Opportunistic infections such as cytomegalovirus (CMV) and toxoplasmosis can cross the placenta and infect the baby, which can cause birth defects.[1]
If you are living with HIV and are pregnant or planning pregnancy, talk to your doctor. They can help to assess and minimise the potential risks of HIV-related health issues for your baby.
Can HIV drugs affect pregnancy?
ART during pregnancy is very important, both for your health and for preventing transmission of HIV to your baby.[3] ART reduces the viral load, which reduces the chances of transmission.[3,7]
If you conceive while on effective ART, you are typically advised to continue your current regimen throughout pregnancy. However, there are instances where changes to your ART regimen may be necessary, such as:[3,7]
- If your viral load is not yet suppressed while on ART.
- If your current ART regimen is associated with side effects that could harm you or your baby.
Certain antiretroviral (ARV) drugs have been associated with harmful side effects, including an increased risk of infant death and prematurity.[3] Speak to your doctor about switching your ART regimen to avoid these potential side effects.
If you are not currently on ART, you will be advised to start treatment as early as possible, ideally by the 24th week of pregnancy, to maximise health outcomes for you and your baby.[3] The selection of ARV drugs during pregnancy is a collaborative process between you and your healthcare provider. This decision considers several factors, including potential side effects, previous drug history, drug interactions, the presence of drug resistance, and the convenience of the ART regimen.[8]
HIV may impact fertility in women in various ways, including:[10–13]
- Menstrual abnormalities such as the absence of periods, which can affect ovulation.
- A higher susceptibility to pelvic infections, which can affect reproductive organs.
- Reduced ovarian reserve, which is the number of healthy eggs.
HIV may also affect fertility in men, possibly leading to:[10]
- Low sperm count, motility, and volume as a result of HIV itself or possibly ART.
- Reduced sperm quality, potentially due to ART.
Fortunately, infertility treatments are available for couples where one or both partners are living with HIV. If you are having difficulty conceiving, consult your doctor to explore the treatment options suitable for you and your partner.[10]
What to expect when you're expectIng
It is important to inform your doctor as soon as possible when you become pregnant. This early notification allows care to begin promptly during your pregnancy.[1,3]
HIV testing is recommended for all pregnant women. If you are living with HIV, a thorough sexual health screening should be conducted, typically including tests for sexually transmitted infections (STIs) and genital tract infections. These additional screenings are important because these types of infections can increase the likelihood of transmitting HIV to your baby.[3]
You will also have a multidisciplinary team (MDT) of healthcare professionals throughout your pregnancy; this team may include:[3]
Your GP or primary care physician
An HIV specialist
An obstetrician
A specialist midwife
A paediatrician
Other specialists
If you need extra support, other experts, such as a psychologist or a patient advocate, may be available.[3]
Throughout your pregnancy, both you and your baby will be closely monitored, with additional tests performed when necessary. These tests may include viral load tests, CD4 cell counts, liver function tests, and HIV resistance testing alongside routine ultrasounds.[3]
You can be rest assured that everyone involved in your care is bound by confidentiality and will not disclose your HIV status unless you provide consent.[3]
Vertical transmission of HIV can occur in three main ways:[14]
- During pregnancy, if your blood crosses the placenta.
- During delivery, if your baby contacts genital secretions and/or blood during childbirth.
- During breastfeeding if your baby ingests breast milk or blood.
If you have an undetectable viral load, there is a very small chance—about 0.1%—of transmitting HIV to your baby.[3,14] Although the possibility is significantly reduced compared to when the virus is detectable, it is not zero.[3]
How to prevent HIV transmission to your baby
There are recommended methods to prevent or greatly reduce the likelihood of vertical transmission; these include:[14]
- Being on ART during pregnancy to reduce the viral load.
- Choosing a caesarean section (C-section) over vaginal delivery.
- Feeding your newborn with formula milk instead of breastfeeding.
- Giving your newborn infant post-exposure prophylaxis (PEP) after birth.
The method of delivery during childbirth depends on your viral load at 36 weeks of pregnancy. If your viral load is undetectable at that time, a routine vaginal delivery is typically recommended. However, if your viral load is still detectable, a C-section is usually advised between 38 and 39 weeks. This is because a C-section reduces your baby's exposure to your genital secretions and blood, lowering the chances of HIV transmission.[3]
Additionally, it is important to deliver your baby in a facility with access to paediatric care, as your baby will need to receive infant PEP and undergo HIV testing shortly after birth.[3]
Your baby will need infant PEP as an extra layer of protection against vertical transmission of HIV.[3] Infant PEP are ARVs given to your newborn baby shortly after potential exposure to HIV to prevent the virus from multiplying.[15]
Infant PEP should be started within four hours of delivery and is usually given for a period between two and four weeks. The length of time that infant PEP is given depends on the likelihood of vertical transmission – this will be based on your viral load at delivery, amongst other factors. If the likelihood is very low, then infant PEP is required for two weeks; however, if it is any higher, then infant PEP may be required for up to four weeks.[3]
Your baby’s first HIV test will be conducted before you are discharged. Additionally, for the first two years of your baby's life, regular HIV tests will be performed.
The typical testing schedule includes:[3]
- 2 weeks old
- 6 weeks old
- 12 weeks old
- An antibody test at 22–24 months old
If your baby was at a higher chance of vertical transmission during delivery or you choose to breastfeed your baby, then HIV tests may be conducted more frequently.[3]
How to feed your newborn baby
Feeding your baby with formula milk reduces the likelihood of vertical transmission of HIV to zero.
However, if you have a fully suppressed viral load, good ART adherence history, and strong engagement with your MDT, then you will be supported to breastfeed your baby if you choose to do so. You should be aware that although having an undetectable viral load does greatly reduce the likelihood of vertical transmission during breastfeeding, there is still a small chance. The concept of undetectable=untransmittable (U=U) only applies to sexual transmission of HIV and is not currently applied to breastfeeding.[3]
Additionally, if you are concerned about the emotional, financial, or social costs of formula feeding, discuss with your MDT what resources are available to help, such as free formula milk or psychological support.[3]
Abbreviations:
ART, antiretroviral therapy; ARV, antiretroviral; CMV, cytomegalovirus; C-section, caesarean section; GP, general practitioner; MDT, multidisciplinary team; PEP, post-exposure prophylaxis.
References:
- StatPearls. Irshad U, Mahdy H, Tonismae T. HIV In Pregnancy. Available from: https://www.ncbi.nlm.nih.gov/books/NBK558972/ [Accessed: December 2024]
- World Health Organization. Mother-to-child transmission of HIV. Available from: https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/hiv/prevention/mother-to-child-transmission-of-hiv [Accessed: December 2024]
- British HIV Association. BHIVA guidelines on the management of HIV in pregnancy and postpartum 2018 (2019 interim update). Available from: https://www.bhiva.org/pregnancy-guidelines [Accessed: December 2024]
- GOV.UK. ISOSS HIV report 2023. Available from: https://www.gov.uk/government/publications/idps-isoss-hiv-outcome-report-2023/isoss-hiv-report-2023#vertical-transmissions [Accessed: December 2024]
- Tukei VJ, Hoffman HJ, Greenberg L. Adverse Pregnancy Outcomes Among HIV-positive Women in the Era of Universal Antiretroviral Therapy Remain Elevated Compared With HIV-negative Women. The Pediatric Infectious Disease Journal. 2021;40(9):821-826. doi:https://doi.org/10.1097/INF.0000000000003174
- NIH. What is an Opportunistic Infection? Available from: https://hivinfo.nih.gov/understanding-hiv/fact-sheets/what-opportunistic-infection [Accessed: December 2024]
- NIH. People With HIV Who Are Taking Antiretroviral Therapy When They Become Pregnant. Available from: https://clinicalinfo.hiv.gov/en/guidelines/perinatal/recommendations-arv-drugs-pregnancy-taking-therapy-when-pregnant?view=full [Accessed: December 2024]
- NIH. Recommendations for the Use of Antiretroviral Drugs During Pregnancy. Available from: https://clinicalinfo.hiv.gov/en/guidelines/perinatal/recommendations-arv-drugs-pregnancy-overview [Accessed: December 2024]
- Mkwashapi DM, Renju J, Michael JM. Fertility trends by HIV status in a health and demographic surveillance study in Magu District, Tanzania, 1994–2018. PLOS ONE. 2023;18(2):e0281914-e0281914. doi:https://doi.org/10.1371/journal.pone.0281914
- Human immunodeficiency virus and infertility treatment: an Ethics Committee opinion. Fertility and Sterility. 2021;115(4):860-869. doi:https://doi.org/10.1016/j.fertnstert.2021.01.024
- King EM, Albert AY, Murray MCM. HIV and amenorrhea. AIDS. 2019;33(3):483-491. doi:https://doi.org/10.1097/qad.0000000000002084
- NHS. Overview - Pelvic inflammatory disease. Available from: https://www.nhs.uk/conditions/pelvic-inflammatory-disease-pid/ [Accessed: December 2024]
- National Cancer Institute. Ovarian reserve. Available from: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/ovarian-reserve [Accessed: December 2024]
- Terrence Higgins Trust. Preventing transmission during pregnancy, birth and breastfeeding. Available from: https://www.tht.org.uk/hiv/living-well-hiv/parenthood/preventing-vertical-transmission [Accessed: December 2024]
- HIV Pharmacy Association. Newborn postexposure prophylaxis. Available from: https://hivpa.org/wp-content/uploads/2018/09/Newborn-PEP.pdf [Accessed: December 2024]
NP-GBL-HVX-COCO-250015 July 2025
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