Question

I’m 6 months pregnant. Is it safe to delay starting treatment?

5 February 2018. Related: All topics, Pregnancy, Southern Africa, Starting treatment.

I am 6 months pregnant and have just tested positive. My CD4 count is 256. I have to start now.

I didn’t get much info as I thought I am doing it for my baby but I find it difficult to deal with the fact that I have developed AIDS, and have to start treatment.

My question is, will it be dangerous for me to delay taking the treatment for myself and only take the one for the baby. Since I think it was my emotional state that made my CD to be low.

I am very healthy and eat well. Please advise.

Answer

Answer: Angelina Namiba

Firstly, congratulations on your pregnancy.

I am sorry about your recent HIV diagnosis. I can appreciate that it cannot be easy dealing with a diagnosis during pregnancy and then knowing that you need to start taking treatment straight away. Can I ask if your doctor has put you in contact with support groups for people living with HIV? Many women find it helpful sharing experiences and coping with being HIV positive and pregnant.

Technically, a CD4 count of 256 doe not mean you have ‘AIDS’ as the US defines this as being less than 200, but it does mean starting treatment is very important.

Your doctor is giving you good advice. Starting treatment (ART) straight away is important.

The WHO (World Health Organisation) guidelines recommends all HIV positive pregnant women start ART. This is regardless of the CD4 count. These meds will be good for your health and good for your baby. The meds should get your viral load to undetectable befire your baby is born. Sometimes this takes longer than three months.

Viral load refers to the amount of virus in your body. An undetectable viral load (below 50 copies) means that there is very little virus in your body and is therefore the best way of preventing transmission to the baby.

Continuing ART afterwards is also recommended, but should be discussed with your doctor. As your CD4 count is 256, it is better to continue taking treatment after the baby is born.

The good news is that ART should increase your CD4 count. Although sometimes if you start taking treatment in pregnancy your CD4 count may not increase very much. If  this happens, don’t worry, your CD4 count will catch up after the baby is born. For more information on HIV and pregnancy, please follow this link to our guide to  HIV, pregnancy and women’s health. The guide also answers a lot of general questions about HIV and pregnancy.

It is good that you eat well and lead a healthy lifestyle. Avoiding stress, eating a balanced diet and taking exercise are all good for your general health and well being. However, this will not necessarily increase your CD4 count. ARVs are the only proven way of increasing and maintaining a good CD4 count.

As you are based in South Africa, you may find it useful to contact TAC (Treatment Action Campaign). They will be able to put you in contact with support groups near you. You may also find it useful to read TAC’s guide to Pregnancy in our lives.

Good luck for the rest of your pregnancy.

Note: This answer was updated in February 2018 from a question first posted online in April 2012.