Q&A: HIV meds and delivery options
I am 33 years old, 13 weeks pregnant and HIV positive. I have been on ARVs for the last year. I exercise, eat lots of fruits and vegetables and make sure that I drink 8 glasses of water daily. I also take multivitamins daily. Last week I went for my first sonar and everything was fine – the heartbeat is excellent and the EFV tablet that I am taking with my ARVs is not affecting my foetus. At the antenatal clinic, I was told that they do not give Nevirapine to the pregnant ladies to take home, as the moms tend to use it when they receive false labour pains. They now keep the tablet in the ward and give it to the mother-to-be when she arrives at the labour ward for delivery. Would that not have a negative effect on my child's HIV status? I have decided to give my child formula milk, will that be fine for my baby's growth? And lastly, would a natural vaginal birth be risky for my child to contract HIV?

Dr Bronwyn Moore (gynaecologist) answers:

The WHO (World Health Organisation) updated its recommendations for mother-to-child transmission prevention in 2010. Transmission can occur during pregnancy, labour and delivery and after delivery through breastfeeding.

The interventions offered vary depending on numerous factors, including your treatment regime pre-pregnancy and your CD4 count. If you are on long-term ARV therapy, then NVP in labour is not needed. Your baby should still receive NVP after delivery, for at least six weeks and even longer if breastfeeding.

Breastfeeding is an option, and if you are on long-term ARVs then six weeks of NVP is recommended for baby. A caesarean section does not significantly reduce the risk of transmission further if you are on ARVs as your viral load should be low.

It does reduce the risk in women not on treatment with high viral loads. Make sure that you discuss your delivery options with your healthcare provider- you can ask for a c-section but in many settings, this may not be feasible.

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