1. If I suddenly go into labour and I am not taking any ARVs, are there any drugs I can take to help my baby?
There are several ARVs you can take during labour. The question of which ones to take and how long to take them for will depend upon drug availability.
WHO recommended in 2006 a combination of single-dose nevirapine + AZT + 3TC for the woman during labour and delivery, followed by a seven-day tail of AZT and 3TC. Immediately after delivery, it is recommended that the baby is given a single-dose of nevirapine, followed by a course of AZT for four weeks.
If drug availability is very limited, a single-dose of nevirapine for the mother during labour and a single-dose of nevirapine for the baby will probably be recommended as a minimum.
2. Is it really safe to take HIV drugs during pregnancy?
Pregnant women are often advised not to take any medications during their pregnancy, so it can seem strange that HIV positive women are advised to take ARVs when pregnant. However, thousands of women have taken HIV drugs during pregnancy without it causing harm to their babies, and it has resulted in many babies being born HIV negative who might otherwise have been infected.
It cannot be guaranteed that HIV drugs taken when a woman is pregnant will not harm her baby. If a woman is not already taking ARVs then as explained above she will probably be advised to wait until after the first trimester before starting treatment. There are specific recommendations and guidelines (see the sources at the end of the page), about certain antiretroviral drugs and which ones are more of a concern than others. The Antiretroviral Pregnancy Registry
3. What else can I do to prevent my baby becoming infected with HIV?
- Is a pre labour caesarean section (PLCS) better than a natural vaginal delivery?
A caesarean section is an operation used to deliver a baby through its mother's abdominal wall. When a mother is HIV positive it is done to protect the baby from direct contact with her blood and other bodily fluids.
Research suggests that with many women now taking ARV combination therapy during pregnancy, having a caesarean isn't a significant factor in preventing the transmission of HIV from mother to baby. Unless you are ill with HIV or have a detectable viral load it usually won't be recommended by your health care provider, as having a caesarean does itself have some risks for the woman. One exception to this is if you are taking AZT on its own, when a PLCS may still be recommended.
- Should I breastfeed?
HIV is found in breast milk, and if you breastfeed there is a significant chance of passing HIV to your baby. So if you have access to safe breast milk substitutes (formula) then you are advised to not breastfeed.
If you live in a country where safe water isn't available, the risk of life-threatening conditions from formula feeding may be higher than the risk from breastfeeding. Formula can also be too expensive to use regularly in some countries. If you are in this situation it is better to feed your baby breast milk alone.
Mixed feeding is when a baby is fed with breast milk and other liquids such as formula, glucose water, gripe water or traditional medicine. It is now thought that there is a higher risk of a baby becoming HIV positive from mixed feeding than exclusive formula feeding alone or breastfeeding. Mixed feeding may damage the lining of the baby's stomach and intestines making it easier for HIV in breast milk to infect the baby but when taking ARVs to prevent mother to child transmission, the risk is reduced and is currently recommended by the WHO.
4. What drugs should I take and when should I take them?
The drugs that can reduce the risk of HIV transmission from a mother to her baby are called antiretroviral (ARV) drugs. ARVs are the drugs that are taken by people living with HIV to prevent them from becoming ill.
The most important time for an HIV positive pregnant woman to take ARVs to prevent her baby becoming infected is during labour. Depending on your particular circumstances it may be suggested that you take ARVs at other times as well.
Deciding exactly which ARVs to take and when to take them can be quite difficult, because there is a need to balance a number of different things, including:
- Your health as an HIV positive pregnant woman
- Reducing the risk of HIV being passed from you to your baby
- The possibility of developing ARV side effects
- The possibility of drugs causing harm to your baby.
- There may also be a difference between which drugs you would ideally take and which ones it is actually possible for you to take, as there is considerable variation worldwide in the cost of ARVs and their availability.
No comments:
Post a Comment