What if I need treatment for my own HIV?
Guidelines currently recommend that all HIV positive people with CD4 counts of about 350 cells/mm3 should be on treatment, including pregnant women. Treatment will also depend on when in your pregnancy you are diagnosed with HIV.
You may only find out that you are HIV positive when you are already pregnant. As mentioned earlier, this can be a very difficult time practically and emotionally. Ask for extra support if you need it.
If you are diagnosed early on in your pregnancy, you may wish to delay starting treatment until the end of the first trimester.
This is the first 12 to 14 weeks from your last missed period. You may also want to delay treatment over this period if you already know your HIV status but have not yet started treatment.
There are two main reasons for delaying treatment.
The first is that the baby’s main organs develop in the first 12 weeks in the womb. This is called organogenesis. During this time the baby may therefore be vulnerable to negative effects from any medicines, including anti-HIV drugs.
Studies have not shown any increased risk to babies whose mothers have used HIV treatment during the first trimester, compared to those who did not use treatment in this period.
A second reason to delay treatment is that most women will experience nausea or “morning sickness” in the early stage of pregnancy. This is very normal.
Symptoms of morning sickness are very similar to the nausea that can occur when starting HIV treatment. You do not want (or need) to have both at the same time. This can also make adherence harder.
If you feel rough because of morning sickness, you are unlikely to want to take any treatments that increase this nausea. And if you are unlucky and get bad morning sickness or are vomiting, this could cause problems with missed doses which may lead to the treatment failing and the development of resistance to anti-HIV drugs.
If morning sickness continues after the first trimester, you and your doctor should take this seriously as it could signal other problems.
If you want to begin treatment immediately, or need to start urgently because you have a low CD4 count, and high viral load, your doctor will recommend it.