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What is HIV?
HIV stands for human immunodeficiency virus. HIV attacks the body's immune system, gradually destroying its ability to fight infections and certain cancers.
Left untreated, HIV can develop into acquired immunodeficiency syndrome (AIDS). This is the most severe stage of HIV and is usually fatal.
There's currently no cure for HIV. However, medication can slow the progression of HIV and delay the onset of AIDS. Many people diagnosed with HIV today stay healthy for many years and have a nearly normal life span.
The U.S. Centers for Disease Control (CDC) estimates that 1.2 million people in the United States are infected with HIV, and about one in eight of those infected don't know they have the virus. About 45,000 new infections occur each year, and 19 percent of those occur in women.
How does HIV spread?
HIV is found in blood and other body fluids including semen, vaginal fluid, and breast milk. To be infected with HIV, fluid from an infected person has to get into your bloodstream.
The most common way for a woman to become infected with HIV is to have unprotected sex with an HIV-positive man. The infection can pass from the man's sperm and through the thin mucous lining of the vagina.
Having unprotected anal sex with an infected partner and sharing needles or syringes also carry a high risk of being infected with HIV.
Other less common ways that you could become infected with HIV include giving oral sex to an infected man, deep kissing when both you and your partner have mouth sores, or being cut by a sharp object contaminated with HIV.
You can also get HIV from receiving a transfusion with infected blood. However, the risk of becoming infected this way is very small because all blood products are screened for the virus and treated with high heat to eliminate germs.
If you're HIV positive, you can pass the virus to your baby during pregnancy, birth, or breastfeeding. The good news is that new treatments mean that fewer babies are being born with HIV.
What are the symptoms of HIV and AIDS?
Some people have no symptoms when they first become infected with HIV. Others develop temporary flu-like symptoms in the first few weeks after being exposed to the virus. These include fever, headache, sore throat, achiness, fatigue, and swollen glands. These symptoms may not seem significant at first because they're similar to flu and generally get better without treatment.
It can take as long as 10 years after infection to develop more severe symptoms. During this time, most people experience a gradual reduction in the number of CD4 cells in their blood. (CD4 cells are the immune system's key infection fighters.)
Healthy adults have between 500 and 1,200 CD4 cells in every cubic millimeter (mm3) of blood. A person with fewer than 200 cells per mm3 starts to develop serious infections called opportunistic illnesses and has progressed to AIDS. Symptoms of AIDS include:
- swollen lymph glands
- rapid weight loss
- frequent fevers and sweating
- persistent or frequent sores in the mouth or vagina
- extreme and unexplained tiredness
Should I be tested for HIV during my pregnancy?
Absolutely. If you're HIV positive, getting proper treatment can significantly reduce your risk of spreading the virus to your baby and is crucial to protect your own health.
The CDC, American College of Obstetricians and Gynecologists (ACOG), and many other organizations recommend that all pregnant women be tested for HIV as early as possible. If you're not offered an HIV test at your first prenatal visit, ask for one.
If you're at high risk for an HIV infection, you should be tested again in your third trimester. You're at high risk for HIV if:
- You're in a relationship with a new sexual partner.
- You don't know the HIV status of your new sexual partner.
- You or your partner inject drugs.
- You exchange sex for money or drugs.
- Your partner is HIV positive.
Although it's best for both you and your baby to begin treatment during pregnancy, getting treatment later is better than not being treated at all. If you haven't been tested during pregnancy, or you're at high risk but your status is unknown, your healthcare provider may recommend rapid HIV testing when you're admitted to the hospital for labor and delivery.
Rapid HIV testing can rule out the condition within 30 minutes, though you'll need another test to confirm the diagnosis if you get a positive result. If you're found to be HIV positive, you can take immediate precautions to reduce the risk of transmitting HIV to your baby during childbirth.
Finally if you weren't tested before delivery, your baby may be tested after birth because starting treatment within 12 hours of delivery lowers a newborn's risk of becoming infected. Newborn testing is voluntary in most states but not all. In New York, for example, all newborns are tested for HIV antibodies.
How can I be sure my HIV test result is accurate?
HIV tests are generally very accurate. However, if you think you have been exposed to HIV, you'll need to wait several weeks before a test is able to detect the virus.
There are several types of HIV tests. Most tests check your blood for the presence of HIV antibodies, or a combination of antibodies and antigens. Your immune system produces antibodies to HIV in response to being exposed to the virus. It takes between three and 12 weeks for your body to make enough antibodies to show up in a test.
Antigens are the part of the virus that antibodies respond to. Because antigens show up faster than antibodies, a test that looks for both antigens and antibodies can detect HIV sooner, usually between two and six weeks after a possible exposure.
If the first test is positive, the result will be confirmed by a second test. A false positive is when the result of the initial HIV test is positive, but the second one is negative. These are rare but can happen. You'll have two tests, so you can be sure of the result.
How can HIV affect my pregnancy and my baby's health?
Your provider's main concern is ensuring you get the right treatment to protect your health and prevent your baby from being infected with HIV. With appropriate treatment during pregnancy, your baby's risk is reduced to less than 1 percent. You may have to:
- Take HIV medication, called antiretroviral therapy (ART), exactly as your provider prescribes during pregnancy and in labor.
- Have a c-section if the amount of HIV in the blood (the viral load) is at an unsafe level at the end of pregnancy.
- Not breastfeed your baby or pre-chew his food when he's older.
- Give your baby antiretroviral treatment until you know for certain that he's HIV negative. (It can take a while for HIV to be detectable in your baby's blood, and this can't be confirmed until he's at least 4 months old.)
About 8,500 HIV-positive women give birth each year in the United States. But thanks to ART and changes in the way pregnancy is managed in HIV-positive women, fewer than 200 babies become infected with the virus annually. This number would be even smaller if all women were tested for HIV prior to conceiving or early in pregnancy, so they could be treated as soon as possible.
How is HIV managed during pregnancy?
If you're already on ART when you discover you're pregnant, don't stop taking medication. A lapse in treatment may cause the virus to become more resistant. Instead, consult a healthcare provider immediately.
In the past, ART was usually only recommended once the viral load and CD4 count suggested that the immune system was compromised. Now the recommendation is to begin ART as soon as possible after diagnosis. So if you haven't already started it, or if you've just been diagnosed, your provider will likely recommend that you begin right away.
The goal of ART is to reduce your viral load to an undetectable level. This protects your health and makes it less likely that HIV will spread to your baby. It can also reduce the chances of infecting your partner if he's HIV negative.
It's possible to have an undetectable viral load between three and six months after starting ART. So, in addition to receiving regular prenatal care, your HIV provider will check your viral load at least every month during your pregnancy until it's undetectable. After that, you'll be checked once every three months.
If your viral load is undetectable at the end of your pregnancy, the risk of transmitting HIV to your baby is very low, and having a vaginal birth may be a possibility. In some cases, (if you have a high viral load near the end of your pregnancy, for example), it's clear that it may be necessary to have a c-section to help prevent HIV transmission to your baby.
How can I cope with the stress of being HIV positive and pregnant?
Being pregnant can be stressful under the best of circumstances. But being pregnant when you have a high-risk condition such as HIV can make it even more so, especially if you have just been diagnosed.
Although it can be hard, focusing on your health right now is the best way to protect your baby from also being HIV positive. And it will mean you'll be well enough to care for your baby as she grows up.
Pay attention to your mental health as well. Let your caregiver know if you're feeling overly anxious or depressed so you can get a referral to a mental health professional, an HIV support group, or both.
How can I avoid getting HIV?
If you're reading this article because you're concerned you may be at risk of getting HIV, there are steps you can take to protect yourself:
- Unless you're sure that your partner is HIV negative, use condoms correctly every time you have sex. That's the case whether it's vaginal, oral, or anal sex.
- Use only water-based lubricants with condoms. Oil-based lubricants can weaken latex and cause it to break.
- If your partner is HIV positive, talk to your healthcare provider about pre-exposure prophylaxis (PrEP), which involves taking medication to protect you from HIV if you're at high risk. PrEP doesn't replace the need to use condoms.
- Avoid contact with anything (such as needles or razors) that might be contaminated with infected blood.
- Never share needles or injection equipment with others. If you abuse injection drugs, there are support services that can help you quit.
Visit the Society for Maternal-Fetal Medicine's website for more information and to find an MFM specialist near you.