Question

I'm planning to have a baby. Should I start taking ARVs?

11 June 2012. Related: All topics, Pregnancy, Sero different couples, South Africa, Starting treatment.

Good day,

Thank you once again for your prompt response on my last email. I do still have a cloud of uncertainty about this disease I have and would really appreciate it if you could clarify a few things for me.

Firstly, I went to see a gynaecologist last year August who advised me to take ARVs. The reason for that was because I was ready to fall pregnant. My CD4 count was 1085 at the time and although very high the gynaecologist insisted that I take the ARVs and actually refused to help me unless I started treatment with immediate effect.

I decided to get a 2nd opinion because my GP was against her diagnosis. As I asked other medical doctors they advised that I did not need to take ARVs as the WHO indicated ARV treatment for patients who’s CD4 count is 350 or below.

My visits to that gynaecologist who insisted I take treatment were cancelled as I felt strong and wanted to wait till I become pregnant to start mother to child prevention, not a lifetime ARV treatment.

I have since tried to do a home insemination with my boyfriend who is HIV negative but it has since failed. I’m still not yet pregnant. Due to the stress I’ve been going through, my CD4 count unfortunately dropped to 635. My plan was to fall pregnant without taking ARVs, but I’m afraid that too is failing.

I’m sooo discouraged lately and am not sure whether to start taking ARVs despite my CD4 count still being above 350 or to persue falling pregnant and taking Nevarapine during pregnancy to protect my unborn child.

I’ve also bought the Atripla pills and the information pamphlet indicated a warning that they shouldn’t be taken if planning to fall pregnant and if currenctly pregnant. Which confused me even more because I am trying to fall pregnant. I’m scared that the longer I prolong the inevitability of taking ARVs the higher my risk will be of conceiving a healthy baby.

Kindly please help me… Should i start taking ARVs or not? And if so, why? Your response is once again appreciated. Thank you.

Answer

Answer: Angelina Namiba

I can appreciate your uncertainty around what is the best thing to do especially when you are given differing advice by different healthcare professionals. Dealing with HIV can be challenging at times and sometimes even more so when you have to make decisions around treatment.

Can I ask if you are in contact with support groups for people living with HIV? I ask because, many find it helpful sharing experiences of living with HIV and ways of coping with making important decisions about our healthcare.

You have asked a number of questions so I will try and respond to them one at a time.

Your first question was whether you need to start treatment straight away, especially as you are planning to have a baby. The second doctor you consulted was correct in saying that you did not need to start straight away.

With a CD4 count of 635, your immune system is still strong. There is therefore no immediate rush for you to start treatment. This is because, both the BHIVA (British HIV Association) and WHO (World Health Organisation) guidelines for treatment recommend starting with a CD4 count of 350 or below. For more information on starting treatment, please follow this link to our guide to combination therapy:
https://i-base.info/guides/starting/when-to-start

However, if you did get pregnant, you would need to take ARVs (antiretroviral treatment for HIV). You will need to take ARVs for the duration of the pregnancy and until after the baby is born. The aim of taking ARVs is to ensure that you have an undetectable viral load by the time you deliver. Viral load refers to the amount of virus in your body. An undetectable viral load (below 50 copies) means there is very little virus in your body and is therefore the risk of passing HIV onto your baby is dramatically reduced.

In response to your second question therefore, conceiving before you start treatment should not prevent you from having a healthy baby. Many women who have tested  HIV  positive during pregnancy, meaning that they got pregnant before they started treatment, and who have subsequently started taking ARVs after, have gone on to have healthy HIV negative babies.

As treatment is individualised, whether you would continue to take treatment after you deliver will depend on a number of factors. These include your CD4 count when you started treatment; how you feel about continuing treatment and sometimes the guidelines in your country.

You mentioned that you haven’t managed to conceive despite several self insemination attempts. Being able to conceive depends on a number of factors including: whether you are both able to conceive naturally; whether you are trying to conceive at your most fertile period – also known as ovulation – (ovulation takes place in the middle of your cycle, about 14 days before your period); or it could also be down to luck. It can take some couples numerous attempts at self insemination before the woman gets pregnant, whereas it takes only one attempt for others. For more information on the best time to try and conceive, please follow this link to our guide to HIV, Pregnancy and women’s health.

Your other question was regarding advice around taking Atripla during pregnancy. Atripla contains the drugs efavirenz, FTC and tenofovir.  In the past, women wishing to conceive were advised not to use  as efavirenz, or to switch if they found out they were pregnant whilst taking it.  However, over the past few years, this advice has now changed. Here in the UK, the current UK guidelines for the management of HIV in pregnancy recommend that efavirenz can continue to be used by women considering pregnancy. They also recommend that efavirenz can be used by women diagnosed HIV positive during pregnancy.

There are many reports of women throughout the world who have have continued taking efavirenz during pregnancy.

You mention that you have already bought the ARVs. Was this on following your doctor’s advice? I ask because it is important that you discuss your plans to have a baby with your doctor. They will be able support you to do this safely as well as advice you on when it will be best to start treatment, as well as what treatment to start with.

Finally, as you are based in South Africa, you may find it helpful to contact TAC (Treatment Action Campaign). TAC, who are based in South Africa, work with and support people living with HIV. They will also be able to put you in touch with a support group near where you live. Their contact details are:

Good luck with your future plans.