AIDS and HIV Infection • Living with HIV and AIDS
HIV and your infant's health
Having a baby
Pregnancy is something you and your partner will need to discuss very carefully with your physician and possibly your counsellor if either or both of you are infected. It is very important to receive medical care early in your pregnancy.
Your HIV treatment should not change very much from what it was before you became pregnant. If you decide to continue your pregnancy, talk with your doctor about how you can prevent giving HIV to your baby. The chances of passing HIV to your baby are about 15-25 percent if you do not breastfeed and 25-45 percent if you do breastfeed.
Antiretroviral drugs associated with replacement feeding have been shown to greatly lower this risk (to 5-10 percent).
Although you are pregnant, you should still use condoms each time you have sex to avoid transmission of HIV or other diseases. After birth, your baby should be tested for HIV, even if you took antiretroviral drugs during pregnancy. Talk with your doctor about your baby's special medical needs and any medications he or she will need.
Breastfeeding is normally the best way to feed an infant. However, if a mother is HIV-infected, it may be preferable to replace breastmilk to reduce the risk of HIV transmission to the infant. The risk of replacement feeding should be less than the potential risk of HIV transmission through infected breastmilk, so that infant illness and death from other causes do not increase. Otherwise, there is no advantage to replacement feeding.
According to joint guidelines from UNAIDS, UNICEF and WHO, the following issues should be considered:
- replacement feeding needs to provide all the infant's nutritional requirements up to 2 years of age as completely as possible;
- breastmilk substitutes must be prepared and given hygienically to avoid contamination with bacteria. This requires access to clean water and fuel;
- breastmilk substitutes must be affordable to families; and
- affordable family planning must be accessible, as women who do not breastfeed lose the child-spacing benefits that breastfeeding can provide.
Some parents may worry that their HIV-infected children might be adversely affected by routine childhood immunizations. In response, WHO and UNICEF have issued the following guidelines. HIV-infected children should be immunized against
- diphtheria, tetanus and pertussis (with DTP);
- poliomyelitis (with OPV or IPV); and
- measles (with measles vaccine),
according to standard schedules.
Children with known or suspected HIV infection are at increased risk of severe measles, and these children should be given an extra dose of measles vaccine as soon after six months as possible, with the scheduled dose given at nine months as usual.
Parents of HIV-infected children are often HIV-infected themselves and have a higher incidence of tuberculosis than the general population. Early protection against tuberculosis with BCG immunization is therefore recommended for HIV-infected children who are not symptomatic. Symptomatic HIV-infected children, however, should not be immunized with BCG or yellow fever vaccine.