Should I expect more side effects when I am pregnant?

Approximately 80 percent of all pregnant women using HAART will experience some sort of side effects with these drugs. This is similar to the percentage of people using HIV treatment who are not pregnant.

Most side effects are minor and include nausea, headache, feeling tired and diarrhoea. Sometimes, but more rarely, they can be very serious.

i-Base have produced a guide Avoiding and managing side effects, which can be very helpful for anyone using HIV-treatment. The sections in this booklet about getting on with your doctor can also be helpful whether or not you are on treatment.

One big advantage of being pregnant is the thorough monitoring at regular clinic visits. This will make it easier to discuss any side effects with your doctor.

Some side effects of HIV medicines are very similar to the changes in your body during pregnancy, such as morning sickness. This can make it harder to tell whether treatment or pregnancy is the cause.

Many HIV medicines can cause nausea and vomiting.

This is more common when you first begin taking them. If you are pregnant, though, such side effects can present extra problems with morning sickness and adherence.

Tips to reduce nausea, and help with adherence are included.

If your morning sickness is bad your doctor may prescribe anti nausea drugs (antiemetics), which are safe to use in pregnancy.

You may feel more tired than usual.

Again, this is to be expected, especially if you are starting HIV treatment and pregnant at the same time. Anaemia (low red blood cells) can cause tiredness. It is a very common side effect of both AZT and pregnancy. A simple blood test checks for this. If you have anaemia you may need to take iron supplements.

All pregnant women are at risk of developing a high blood sugar (hyperglycemia) and diabetes during pregnancy.

Women taking protease inhibitors in pregnancy may have a higher risk of this common complication. So, you should be sure to have your glucose levels closely monitored and be screened for diabetes during pregnancy. This is routine for all pregnant women.

Outside of pregnancy, protease inhibitors have been associated with increased levels of bilirubin.

While this is usually a measure of the health of your liver this is not always the case as with the the protease inhibitor atazanavir. Here bilirubin levels can be very high but without causing any problems.

The levels of bilirubin in the baby may also be higher than normal and your healthcare team will follow your baby’s bilirubin levels very carefully and may give the baby phototherapy to reduce the levels of bilirubin.

Although extremely high levels of bilirubin may damage a baby’s developing brain there have not been any reports of this occurring with atazanavir.

In the UK over 150 mothers have taken atazanavir in pregnancy and it appears to be fairly safe for mothers and their babies.

Pregnancy may be an additional risk factor for raised levels of lactic acid.

Your liver normally regulates this. Lactic acidosis is a rare but dangerous and potentially fatal side effect of nucleoside analogues.

Using d4T and ddI together in pregnancy appears to be particularly risky for lactic acidosis.

This combination is now not recommended in the UK. Consequently the risk of lactic acidosis is now extremely low.