HIV medication in pregnancy

HIV medication in pregnancy

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What are antiretrovirals, and what is antiretroviral therapy (ART)?

Human immunodeficiency virus (HIV) is called a retrovirus, so the drugs used to treat HIV are called antiretrovirals (ARVs).

HIV attacks the body's immune system and kills the infection-fighting white blood cells called CD4 cells. HIV spreads when viral DNA gets incorporated into a CD4 cell's DNA, and HIV "hijacks" the CD4 cell's system to copy the virus. This is called the HIV life cycle.

ARVs can't cure HIV, but they can stop the virus from making copies of itself, or replicating.

There are six classes of ARV. Each type targets a different stage in the HIV life cycle, so combining several types of ARV into one treatment is the most effective way of treating HIV. This treatment is known as antiretroviral therapy, or ART.

ART is very effective. It can lower the amount of HIV in the body to levels that are almost too small to detect, helping you stay healthy and live longer. It also means you're less likely to pass the virus on to sexual partners.

During pregnancy, ART reduces the risk of passing HIV on to your baby.

Is ART recommended during pregnancy?

Experts recommend ART for everyone who is HIV positive. ART reduces the amount of HIV in the body (the viral load). But it's especially beneficial if you're pregnant or planning to get pregnant.

If your viral load is low, the risk of passing HIV to a baby during pregnancy and delivery is low. Taking ART can reduce your baby's risk of contracting HIV to 1 percent or less.

When you're getting treatment, that means your baby is too. Some ART medications can pass from you to your unborn baby through your placenta. These medications help protect your baby from becoming infected with HIV.

If you were already on ART before becoming pregnant, it's possible that your healthcare provider may revise your ART regimen or your dose. Some HIV medications may not be as safe to use during pregnancy, or your body may respond to them differently.

If you're not on ART (either because you didn't want to be or because you have just been diagnosed with HIV), your provider may recommend you start right away.

Are antiretroviral drugs safe to take during pregnancy?

Many HIV medicines are considered safe to take during pregnancy. Research is ongoing, but there doesn't seem to be a clear link between HIV medicines and birth defects. There have been some concerns that ART could be associated with an increased risk of some pregnancy complications, such as preterm birth, but there's a lot that isn't known.

You won't be given any drugs that are known to be dangerous for a developing baby, but there isn't a lot of safety data for most of the newer medications.

On the other hand, the effects of not treating HIV are well known, and the U.S. Public Health Service currently recommends that women receive medication unless known adverse effects outweigh benefits. In all cases, your provider should inform you of the potential risks, benefits, and unknowns of your treatment options, and involve you in the decision-making process.

When you see your HIV provider, be sure you ask plenty of questions about the medication you're taking. Tell her about any other medication you're taking or plan to take, including vitamin supplements and herbal remedies – these could influence how effective ART is. She will tell you what is known about the potential risks and benefits of your medication options.

You'll also want to know about common side effects. These don't usually last long but might include nausea, diarrhea, headaches, or tiredness. Your provider can give you medication to help you manage these.

Possible longer term side effects include:

  • bone thinning (osteoporosis)
  • a buildup or loss of body fat in particular areas of the body (lipodystrophy)
  • high levels of fat in your blood (hyperlipidemia)

By having this information, you can be involved in deciding if a particular HIV drug is right for you. Your provider will monitor you for signs of any complications during your prenatal appointments. Don't stop taking ART or make changes to your regimen without talking to your provider.

There is continuing research into the safety of all HIV medications. If you're taking HIV medicines during pregnancy, your provider may ask you to voluntarily enroll in the Antiretroviral Pregnancy Registry.

This registry contributes to the research by monitoring exposure to HIV medicines in pregnancy. The aim of doing this is to detect any risk of birth defects caused by HIV medications.

How do I pay for ART?

If you have health insurance, you'll be covered for some medicines used to treat HIV. If you don't have health insurance, or you can't afford your co-payment or co-insurance amount, help is available.

Medicaid may pay for your treatment during pregnancy and after you deliver your baby. Medicaid income limits are higher for HIV treatment during pregnancy, so even if you thought you didn't qualify, it's worth checking again.

There are also other government and community programs that you may be eligible for. Your healthcare provider or local public health department can help you find out what's available.

What is adherence, and why is it so important?

Adherence means taking your ART exactly as prescribed. Missing a dose, or taking it at the wrong time, can quickly result in an increase in the viral load. This can put your health, and your baby's health, at risk.

Drug resistance can also develop if you miss doses. This happens when the drugs you've been taking no longer work against HIV.

Remembering to take your ART may not sound difficult, but it's not unusual to struggle with it. You could be taking several tablets at different times each day. Some ART medication has to be taken with food, or at particular times before or after a meal.

Even if you're usually good at taking your ART, you may have problems when you're expecting. Nausea in early pregnancy could mean you don't feel like eating at regular times, and tiredness may throw off your normal schedule.

It's important that you're honest with your healthcare provider and let her know if you're not able to follow your regimen. She may be able to move you to an easier combination of ARVs or offer support to help you stay on track.

Visit the Society for Maternal-Fetal Medicine's website for more information and to find an MFM specialist near you.

Watch the video: Mother to Child Transmission of HIV - Episode 3 (June 2022).


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