Associated with high treatment costs and as yet no cure, human immunodeficiency virus (HIV) continues to be one of the most important communicable diseases in the UK. There are two types of HIV – HIV-1, which is the cause of the worldwide spread of AIDS, and HIV-2, which is primarily found in West Africa. The three main methods of transmission of HIV are by blood (or blood products), through sexual contact and through transmission from mother to child during the pregnancy, birth or through breast feeding. Click here for further general information on the disease (automatic link to Childhood Diseases website).
HIV-1 has become an important and common complication of pregnancy and there are guidelines specifically for the treatment of the disease in pregnancy:
British HIV Association guidelines (select ‘pregnancy guidelines’ in the index).
HIV infection during pregnancy is associated with poor pregnancy outcomes as it appears that there is an increase in the risk of stillbirth, preterm delivery and increased chance of low birthweight babies due to growth retardation in the uterus. The most serious effect of HIV-1 however, is transmission from the mother to the baby. This can occur in the uterus, during delivery and after the baby is born (predominantly via breast milk). With routine antenatal screening, appropriate treatment, Caesarian section and exclusive artificial formula feeding (where possible) mother to child transmission is, in the main, preventable.
A woman diagnosed as HIV positive during her pregnancy, will be looked after by a team that will include a midwife, a specialist nurse, an obstetrician, a paediatrician and an HIV specialist and may also include psychiatric and support groups. Interventions to reduce the risk of mother to child transmission during pregnancy and childbirth include antiretroviral therapy (e.g. zidovudine) given to the mother during pregnancy and birth, and to the baby for the first 4 to 6 weeks of life. The mother also undergoes a Caesarean section. Caesarean section has been shown to reduce the transmission of HIV-1 from mother to baby by approximately 50% and it is recommended that women who are HIV-1 are delivered via Caesarean section. Where a woman opts for a vaginal delivery, however, there are measures that can be taken to reduce the risks of transmission. Such measures include augmenting labour if contractions are weak in order to avoid a prolonged-membrane-rupture-delivery interval, avoiding invasive techniques such as direct cardiotocograph (CTG) monitoring through foetal clips, avoiding foetal blood sampling and to restrict use of episiotomies. Delivery with instruments such as forceps or ventouse should be avoided wherever possible in order to minimise abrasions to both mother and baby. Whilst all these recommendations have been made, however, it is important to remember that decisions must be made on an individual basis.
Click here for information on HIV screening in pregnancy and the counselling of patients.