HIV drugs and the baby’s health
Some mothers and doctors have been reluctant to use or to prescribe anti-HIV drugs during pregnancy. This is out of concern for unknown effects to the baby.
It is difficult to know if there are any long-term effects.
Children first exposed to combination therapy are not likely to be much older than 15 now.
Careful follow-up of children exposed to AZT has not shown any differences compared with other children.
All children born to HIV positive women in the UK (and many other countries) are also being monitored. This close monitoring will provide important safety information in the future.
Ultimately, it seems clear that the biggest risk to a baby born to a mother with HIV is HIV itself. HIV drugs can prevent this.
Will HIV drugs affect the baby?
These concerns are justifiable. Unfortunately there are no definite answers, but the available evidence so far shows that the drugs appear to be safe.
Some reports have looked at the risk of prematurity, birth defects and toxicity in babies.
Prematurity
Several studies show a greater risk of prematurity (baby born at less than 37 weeks) and low birth weight for babies born to mothers taking anti-HIV treatment with three or more drugs.
A recent British study found an overall rate of 13 percent (normally the rate here is about 6-8 percent).
This should not be a reason for a mother to avoid treatment in pregnancy, particularly if she needs it for her own health. It is important to be aware of the risks though, discuss them with your healthcare team and make sure that you are receiving the best possible treatment, care and monitoring for yourself and your baby in your situation.
Can anti-HIV drugs cause birth defects?
There have been very few reports of birth defects in babies whose mothers have taken these drugs in pregnancy. The only caution at the moment is possibly with the two drugs ddI and nelfinavir, neither of which is recommended in pregnancy in the UK.
What about mitochondrial toxicity?
Mitochondria are the “energy producing factories” within our cells. There have been a small number of reports that the use of 3TC and AZT in pregnancy may be linked to mitochondrial damage in children.
In a large study from America, medical records of over 20,000 HIV negative children born to HIV positive mothers were searched for abnormalities associated with mitochondrial damage. The study was designed after reports from France of two deaths of infants exposed to AZT and 3TC and six other cases of mitochondrial toxicity.
This large study failed to show evidence of fatal mitochondrial damage in children exposed to these drugs during their mothers’ pregnancy. This was very reassuring.
In a rare number of cases though, short-term mitochondrial toxicity can be a problem in newborn babies. A very small number of babies have been reported with severe lactic acidosis and anaemia believed to be linked to anti-HIV drugs. All have recovered with appropriate care.
Some studies have suggested that these mitochondrial damage effects are not seen when these drugs are used in HAART.
What about anaemia?
Anaemia has been reported in babies born to mothers on HIV medications but this passes quickly and rarely requires a transfusion.
Will my baby be monitored for these symptoms?
Yes. Babies born to HIV positive mothers on treatment will be monitored very carefully.