What if I do not need treatment for my own HIV?
UK guidelines recommend starting treatment while your CD4 count is about 350 cells/mm3. Treatment is not currently recommended at much higher CD4 levels unless you have HIV related health problems. However, studies show that HIV treatment can reduce the risk of transmission even with mothers who had low viral loads that are less than 1,000 copies/mL before they started treatment.
Transmission dropped from almost 10 percent in untreated women to less than one percent in women treated with anti-HIV drugs.
As a result, treatment or prophylaxis is offered to all HIV positive pregnant women, even those with CD4 counts over 350 cells/mm3 who have never been on treatment before.
British HIV pregnancy guidelines recommend two options for women in this situation who have higher CD4 counts:
Use Short Term Triple Antiretroviral Therapy (START). With START, you begin treatment during the second trimester at 20 to 28 weeks, and then stop after delivery. You can choose to plan a Caesarean section at 38-39 weeks or a vaginal birth.
Use AZT monotherapy (as in the 076 study) and have a planned pre-labour Caesarean section at 38 weeks.
The second option is only suitable for women with a high CD4 count and a low viral load who would not need to use ARV treatment for several years. This option is rarely used now.
Choosing START does not mean you will definitely not have a Caesarean section. You may need to for other obstetric reasons.
You will need to recognise the benefits and risks of these two options. Discuss and consider the following very carefully until you are happy with the approach you are going to use.
Benefits of START:
- Using three drugs will reduce your viral load to undetectable.
- You will have a choice over mode of delivery.
Risks of START
- You and your baby will be exposed to a greater number of drugs, which may increase the risk of premature delivery.