When HIV treatment is used during pregnancy, it protects your health as well as playing an important role in preventing HIV being passed on from you to your baby during pregnancy and birth.

In the UK, because of high standards of care (as set out in BHIVA guidelines on HIV treatment during pregnancy), the risk of mother-to-child transmission is very low. For women who have been diagnosed and who receive the right advice, treatment and care, the risk is below 1%. For women who are on effective HIV treatment and who have an undetectable viral load, risk of transmission to their baby is 0.1%, or one in a thousand.

Increasingly, evidence suggests that being on HIV treatment during pregnancy is not harmful. Taking HIV treatment during pregnancy greatly reduces the risk of passing on HIV to the baby, so the benefits outweigh any risks. More information continues to be collected on the use of anti-HIV drugs during pregnancy; there are some drugs with more safety information available than others. Your doctor will discuss options with you.

A baby conceived when the father is on treatment will not be affected by the anti-HIV drugs.  

Generally, anti-HIV drugs are not used during the first three months of pregnancy unless you are already on treatment. Pregnant women are recommended to start HIV treatment between 14 and 24 weeks of pregnancy (depending on your health and viral load), unless you need to take it earlier for your own health. You may also be recommended to start earlier if you have a very high viral load.

As a woman’s health improves, her fertility may also increase. If you are thinking about becoming pregnant, it’s recommended you discuss this with your healthcare team before you try to conceive. You should tell your HIV doctor or another member of your healthcare team immediately if you become pregnant. You can discuss your treatment options with them, and they will often help to arrange your antenatal care and work with other staff, such as an obstetrician and an HIV specialist midwife, to ensure you get the appropriate care.

Adhering to your treatment can be especially difficult during pregnancy or in the period after giving birth. It therefore makes very good sense to tell someone at your HIV clinic if you have any concerns or questions about your treatment or are missing doses. Help will be available. Good adherence to your treatment at this time will help reduce the risk of mother-to-child transmission of HIV to very low levels and also protect your own health.

Some forms of hormonal contraception, including patches and implants, are less effective in women on many of the anti-HIV drugs, because of drug interactions. Most other forms of contraception are unaffected by having HIV or being on HIV treatment and some new drugs do not affect contraception. You can find out more about contraception options from your HIV clinic.

You can also find out more about HIV, contraception and the options available to you by using NAM’s online tool HIV & contraception at www.aidsmap.com/contraception

You can find out more about HIV treatment during pregnancy in the booklet in this series, HIV & women and you can get personalised information using our online tool HIV & pregnancy: www.aidsmap.com/pregnancy.