Human immunodeficiency virus (HIV) can be transmitted to your baby during pregnancy, during delivery or from breastfeeding. However, there are ways to significantly reduce the chances that your baby will become infected.
During your pregnancy, you should take antiretroviral drugs daily (used to treat or prevent HIV) to lower the risk of passing the infection to your baby – even if your HIV viral load is very low.
Your baby should take one or more antiretroviral drugs for the first 4 or 6 weeks of life. If you and your baby do not take antiretroviral drugs, there is about a 1 in 4 chance that your baby will get HIV. However, if you and your baby take every dose of the drugs, the chances of your baby being infected with HIV drops to below 1% (1 in 100).
These drugs have been used during pregnancy and in newborn babies for over 25 years. So far, children exposed to these drugs during pregnancy and as babies haven’t had major problems in infancy and childhood. But, it is still too early to tell whether there may be late effects as children become adults.
The best way to deliver your baby (by Caesarean section or vaginally) depends on how much of the virus is in your blood (your HIV viral load) near the time of delivery. Your doctor can give you advice on what is right for you. If your viral load is high, your doctor will likely recommend a Caesarean section to prevent your baby from getting HIV during labour. If your viral load is low, your doctor will probably recommend a vaginal delivery unless there is some other reason why you need a Caesarean section.
Blood tests, like those that determine your HIV viral load, can detect if your baby has HIV. Usually 3 blood tests are done:
Within the first few days or weeks after birth
If these tests are negative for HIV, your baby doesn’t have the virus. Many doctors will confirm this by testing your baby for HIV again at around 18-24 months of age.
If any of the tests come back positive, another test is performed as soon as possible to confirm whether your baby is infected with HIV. If your baby is infected, treatment with antiretroviral drugs should start and continue indefinitely. These drugs may be different from the drugs given in the first 4 to 6 weeks. Treatment is effective, safe, and will help keep your baby healthy.
We recommend that you feed your baby infant formula instead of breast milk, as the baby could get HIV from breast milk, even if your viral load is undetectable.
If you are considering breastfeeding your baby, it is very important that you discuss this with your HIV specialist and your baby’s HIV doctor, ideally before your delivery. They will discuss the potential risks and benefits of breastfeeding versus formula feeding.
If after this discussion, you decide to breastfeed, your doctor and your baby’s doctor can explain how to lessen the risk, and if needed, refer you to skilled professionals that will support you while you breastfeed. They may also want to change the type of antiretroviral drugs for you and your baby, and give them to your baby for longer than 6 weeks.
Yes, your baby should get the same vaccines as other babies. The only exception is BCG, a vaccine against tuberculosis, which is occasionally given to newborns if there is an outbreak of tuberculosis in the area.
If you also have hepatitis B, your baby should be vaccinated at birth.
Usually yes. However, if you live far from a big city, your doctor should check with someone who specializes in HIV in children to find out what medicine to give your baby and what blood tests to do. It may be possible to have the blood tests done at your closest laboratory.
Testing for HIV during pregnancy
HIV transmission through breastfeeding (Ontario HIV Treatment Network)
Pregnancy and Infant feeding (CATIE)
Infectious Diseases and Immunization Committee
