Will I need extra tests and monitoring?

HIV positive pregnant women do not need any extra monitoring for HIV. This should be the same as for any non-pregnant HIV positive adult.

You will have a resistance test before you start ART (unless you are diagnosed very late).

If you become pregnant before starting ART, you should have at least one CD4 count before you start. If you are already taking ART, this test will be when you first discover you are pregnant. You will have another CD4 test after the baby is born.

If you start ART in pregnancy you should have several viral load tests. The first test will be 2 to 4 weeks after starting. Then you will have at least one every trimester, at 36 weeks and delivery.

Some doctors might recommend TDM (therapeutic drug monitoring) if your viral load is not declining at the expected rate. TDM is a blood test to check whether you are absorbing the right amount of a drug. Drug levels, particularly of PIs, can vary between individuals. They can be lower during pregnancy. Occasionally this can lead to a dose adjustment.

Your doctor will also discuss your adherence and perhaps do another resistance test. Sometimes this might mean changing one or more of your HIV drugs.

You will be tested for hepatitis, syphilis and other STIs, anaemia and TB. You might also be tested for other common infections that can be transmitted to your baby. The tests should be done as early as possible in your pregnancy. You should be treated for these if necessary.

Most tests you have will be routine for pregnant women. These might vary slightly from clinic to clinic. Routine tests include blood pressure, weight, blood and urine tests as well as foetal monitoring.

A test is called invasive if a needle or tube enters the body in some way. An example is amniocentesis which is a diagnostic test sometimes carried out during pregnancy. It can assess whether the foetus could develop, or has developed, an abnormality or serious health condition.

You might need an invasive test when your viral load is still detectable. In this case you should start ART with an integrase inhibitor such as raltegravir. You will also be given a single dose of nevirapine 2 to 4 hours before the test.

Unless you need extra care you will probably visit your clinic monthly (or even less if your viral load is less than 20 copies on ART from conception) for most of your pregnancy. Visits will be every two weeks after the eighth month.