An important choice that HIV positive women have to make is whether or not to have a child and what (if any) intervention should be used to reduce the risk of transmission from Mother-to-Child.
HIV positive women who are pregnant or considering pregnancy, have a 1 in 4 chance of passing the virus on to the fetus. Although the precise mechanisms are not known, scientists believe that HIV may be transmitted when maternal blood enters the fetal circulation or by mucosal exposure to the virus during labor and delivery. The risk of prenatal transmission is significantly increased if the mother has advanced HIV, large amounts of HIV in her bloodstream or few of the immune system cells – CD4+ T cells – that are the main targets of HIV.
Maternal drug use, severe inflammation of fetal membranes, or a prolonged period between membrane rupture and delivery are also seen as elements that contribute to the possibility of Mother-to-Child infection. A recent study by a US based group found that HIV positive women who gave birth more than four hours after the rupture of the fetal membranes were nearly twice as likely to transmit HIV to their infants, as compared to women who delivered within four hours of membrane rupture. Breast feeding introduces an additional risk of HIV transmission of approximately 14 percent.
The chances of Mother-to-Child transmission can be reduced to 1 in 12 if the woman takes specific drug therapies to reduce transmission. In some cases, a 200mg pill of nevirapine (an anti-retroviral drug) given to the mother during labor and a spoonful of the syrup to the baby within 72 hours of its birth has proved to be quite effective in reducing the risk of transmission.
Research data also suggests a 50 per cent reduction in transmission where C-section is performed as compared to vaginal delivery in non-breast feeding population. By combining the use of ARV drugs and elective C-section, transmission rates have been brought down to two per cent in non-breast feeding population. Similar results have also been obtained by using ART without the use of C-section.
Due to the success of such treatments, it is recommended that all pregnant women be tested for HIV so they can make early decisions about treatment to prevent transmission. In the US alone, about 6500 HIV positive women get pregnant and give birth annually. However, due to the availability of information and timely treatment, only about 25% of the babies are HIV positive.