Anyways... on this topic of having babies... I would like to share with you part of a recent e-mail I received. After my (unfulfilling) doctor's appointment a couple months ago, I reached out to a Pediatric HIV Nurse friend to get some better answers about the specific risks and processes involved in a HIV pregnancy. This information comes from a nurse practitioner who follows the children in the clinic who either have HIV or have been exposed to HIV either through childbirth, sexual assault, needle stick injury or some other potential exposure. She follows all of the babies in a 17 county radius who have been exposed in utero to HIV.
"I have researched for the latest data to give you and I find that according to the CDC as recently as 5/2013, they state that as long as a woman knows of her HIV status either prior to the pregnancy or early on in the pregnancy, receives appropriate health care (especially prenatal care), get their viral loads to undetectable and avoids breastfeeding, the rate of transmission is less than 1%. From 2007-2009 the rate of babies diagnosed with HIV went from 0.8% to 0.1% in Caucasian women. The rates for Hispanic and African/American babies is a bit higher. Some of the reasons given for increasing the risk of transmission were lack of appropriate prenatal care, lack of prenatal HIV testing, lack of prenatal antiretroviral medication, not performing Cesarean delivery for women with a viral load greater than 1,000 copies per mL and not educating women on the avoidance of breastfeeding.
Given the information that you gave to ******, I feel that your risk would be in that less than 1% of transmitting HIV to your baby. I have worked with this population for 12 years now and in my experience I have seen 2 babies become positive from maternal transmission. In one case the mother was absolutely awful with taking her medications and had a very high viral load. This was all despite aggressive education and concern by numerous different staff members from the OB service, our service and mom's care providers. In the other, I suspect that was the case as well, but I don't have specifics as the child was adopted from the hospital. I do know that this mother was a drug user and the child had drugs in her system at birth. Because the biological mother never came to see me, I could never get permission to get her records so I had very little information on her actual medical care and all that I have I have needed to piece together from bits and pieces that I have gotten over the last couple of years, but from what I can tell she probably did not take her medications well, if at all, and I do know she did not seek care until late in her pregnancy.
It is the standard of care for mom's to get ARV's during the pregnancy. The official recommendation is that the woman should have a regimen that includes Zidovudine in it and I usually recommend that if I am asked, but I have seen many women without Zidovudine and as long as their viral load is low the baby is fine. It is then standard of care that once a woman goes to the hospital she should get an IV started with Zidovudine running from the time she goes in to deliver, until the baby is born. If scheduled for a c-section or induced labor, that is factored in and started about 2 hours prior to the section or the start of induction medications. If the baby decides to take matters into his or her own hands and comes either before the medications can be administered or before the full dose is in, as long as the mom was undetectable and had good prenatal care and did everything correct, I am never concerned about it. After the baby is born, he or she should receive zidovudine for the first 6 weeks of life. That should be started as soon after delivery as possible, but most definitely within 6-8 hours of birth. If the mom's viral load is high or if we do not have that information because mom was a late care seeker, etc, we also give another medication called Nevirapine. That is given 3 times within the first week of life and shown to help to prevent transmission when there is a high viral load. It has not been shown to be any more effective in babies born to mothers who have undetectable viral loads so we do not give it as an added precaution in babies who do not have that added risk.
The site that I accessed the information from was http://www.cdc.gov/hiv/risk/
I am so thankful for this updated information and statistics. I hope you find them as enlightening and encouraging as I do!