HIV in Pregnancy: Risks, Precautions and Treatment Options

What is HIV in Pregnancy?

HIV in pregnancy means being pregnant while living with the Human Immunodeficiency Virus (HIV).

HIV attacks CD4 cells, weakening the immune system and, if untreated, can progress to Acquired Immunodeficiency Syndrome (AIDS). During pregnancy, it affects maternal immunity and raises the risk of transmitting the virus to the baby.

With modern treatment, HIV in pregnancy is manageable. Antiretroviral therapy (ART) can suppress the virus to very low levels, enabling a healthy pregnancy and safe childbirth.

How Common is HIV in Pregnancy?

HIV in pregnancy is relatively uncommon but closely monitored through public health programmes. Globally, about 1.3 million women living with HIV become pregnant each year (WHO).

In India, new HIV infections have fallen by around 44% since 2010, outperforming the global trend. Improved routine antenatal HIV testing and early treatment have contributed to this decline. NACO data also shows a steady reduction in mother-to-child transmission, thanks to wider screening and better access to antiretroviral therapy during pregnancy.

Can HIV Be Transmitted to the Baby During Pregnancy?

Yes, HIV can be passed from mother to baby, but proper treatment greatly reduces the risk.

Transmission can occur:

• During pregnancy (via the placenta)
• During labour and delivery
• Through breastfeeding

Without treatment, the risk is 15-45%. With consistent antiretroviral therapy, careful delivery planning and proper infant care, the risk drops to around 1-2%.

What Factors Increase the Risk of Mother-to-Child Transmission?

The main factor is a high maternal viral load, especially in late pregnancy and around delivery. Poorly controlled HIV significantly raises the risk.

Other risk factors include:

• Late HIV Diagnosis: Less time to suppress the virus before delivery; around 80% of in-utero transmissions occur in the final weeks.
• Poor Adherence to ART: Skipping or stopping treatment increases viral levels and transmission risk.
• Co-Existing Infections: STIs or other infections can increase viral shedding.
• Prolonged Labour or Premature Rupture of Membranes: Longer exposure to maternal blood increases risk. Without intervention, over 50% of transmission events are linked to labour and delivery-related factors.
• Infant Feeding Practices: Mixed feeding (breast milk + formula) raises transmission risk compared to exclusive breastfeeding.

How is HIV Diagnosed During Pregnancy?

HIV is diagnosed with a simple blood test, usually offered at the first antenatal visit. High-risk women may be retested later, often in the third trimester, to detect new infections.

Early diagnosis allows prompt treatment, improving outcomes for both mother and baby. HIV testing is confidential, voluntary and supported by pre- and post-test counselling.

Is Antiretroviral Therapy Safe During Pregnancy?

Yes, antiretroviral therapy (ART) is considered safe and essential during pregnancy. The therapy works by suppressing viral replication, lowering the amount of virus in your blood. Most commonly used ART regimens have been extensively studied and shown to be safe for pregnant women and developing babies.

Benefits of ART during pregnancy include:

• Protecting your immune system
• Reducing pregnancy-related complications
• Minimising the risk of HIV transmission to the baby

What Precautions Should You Take if You Have HIV in Pregnancy?

The most important part of managing HIV in pregnancy is staying on treatment and keeping up with medical care. These steps help protect your health and greatly reduce the risk to your baby.

Key precautions include:

• Taking ART daily, exactly as prescribed.
• Attending all antenatal appointments, even when feeling well.
• Regular blood tests to monitor viral load and CD4 counts.
• Prompt treatment of any infections, including UTIs or STIs.
• Avoiding smoking, alcohol and any unprescribed medications that could affect pregnancy or treatment.

How Does HIV Influence Delivery Options?

Delivery decisions for women with HIV depend on how well the virus is controlled near the time of birth.

• If the viral load is well suppressed with treatment, vaginal delivery is generally considered safe.
• If viral levels remain high, a planned caesarean section may be recommended to reduce the risk of mother-to-child transmission.

Your doctor will review your latest test results and overall pregnancy health to determine the safest delivery method for you and your baby.

What Treatment Options Are Available for the Baby After Birth?

Babies born to mothers with HIV receive preventive treatment after birth. This usually includes:

• Antiretroviral medication for a few weeks
• Early HIV testing at recommended intervals
• Regular paediatric follow-up

These measures further reduce the already low risk of transmission and ensure early detection if needed.

What is the Long-term Outlook for Mothers and Babies?

With proper care, the long -term outlook is very positive. Women living with HIV who stay on treatment can expect a normal life expectancy. Children born HIV-negative remain healthy and even in rare cases of transmission, early treatment allows children to grow and develop well.

Ongoing medical care, emotional support and access to reliable information play a key role in long-term health and quality of life.

Conclusion

HIV in pregnancy is a manageable condition today. With early testing, consistent antiretroviral therapy and regular antenatal care, you can protect your health and dramatically reduce the risk of transmitting HIV to your baby.

Being diagnosed during pregnancy can feel overwhelming, but you are not alone. Advances in medical care mean many women with HIV now have healthy pregnancies and HIV-negative babies. Staying informed, adhering to treatment and trusting your healthcare team empowers you to navigate pregnancy with confidence and hope.