HIV pregnancy planning

With medical advances over the past 2 decades, more and more people living with HIV are choosing to have children. If you or your partner are living with HIV and are planning a pregnancy, all the typical pre-conception recommendations apply – eat well, take folic acid, try to achieve a healthy weight, abstain from alcohol and other substances, and so on. It is very important to see a health care provider prior to conceiving to discuss medications and other special considerations. If one member of a heterosexual couple is HIV-positive and the other is not, it is important to try not to transmit HIV to the uninfected partner while trying to achieve a pregnancy. It is possible to prevent transmission.

How likely is HIV transmission to my baby?

Together, antiretroviral therapy, Caesarean delivery, and not breastfeeding have reduced the chances of transmitting HIV to the baby to less than 1%. In the absence of such preventive measures, transmission rates can be as high as 42%.

Do I keep taking my medications?

It is important to continue antiretroviral therapy in the pre-conception period to reduce viral load. This helps prevent transmission to your partner and/or the baby. Once you are pregnant, your health care provider (an HIV specialist and/or pharmacist) will adjust your therapy to the safest regimen for the fetus. Tell your HIV specialist about your intent to become pregnant so that any necessary changes in medications can be part of your planning.

What if my male partner is HIV positive?

If you are attempting to become pregnant and your partner is HIV positive, you are at risk of contracting HIV. If your partner is not taking antiretroviral therapy, your risk of transmission is 0.1% to 0.3% per act of intercourse. One option to reduce this risk is to have a ‘sperm washing’ procedure conducted at a fertility clinic, followed by artificial insemination.

What options are available to reduce the risk of HIV transmission to the uninfected partner?

There are many fertility techniques that can reduce the risk of HIV transmission to the uninfected partner. These include:

  • Artificial insemination
  • Sperm donation
  • In vitro fertilization
  • Sperm washing
  • Direct injection of a sperm into an egg