In pregnancy, an HIV positive woman will be managed by a multi-disciplinary team from HIV and maternity care services. As in all pregnancies, a woman centred care approach should be adopted that facilitates the woman and her partner in decision making. Regular monitoring of the woman's viral load will be central to decisions regarding obstetric management.

Combination treatment is recommended for all HIV positive women and to continue lifelong.

If a woman chooses not to commence treatment, it should be then commenced in the following situations:

• There is clinical evidence of immunosuppression (classic HIV related conditions)
• CD4 count is < 350, while asymptomatic
• Pregnant – as soon as possible in the second trimester, or first trimester if VL>100,000 or CD4 < 200 cell/mm. All women should have commence ART by week 24 of pregnancy.

Choices for delivery when the woman is HIV positive

In addition to the woman's choice, viral load measurement plays a key part in deciding the mode of delivery. The overall aim is to increase women's choice in relation to vaginal delivery or planned caesarean section (CS) and reduce the need for emergency CS. The aim of starting treatment early in pregnancy is to allow time to reach viral load suppression by week 36 gestation. Decisions regarding delivery are made by the woman in conjunction with the HIV and maternity care team.

Experience of HIV and pregnancy

This video follows the journey of Kate (HIV positive) and her partner John (HIV negative) from deciding to have a baby, through pregnancy and after the birth of their baby. It is interspersed with advice from key medical professionals. 

As with all of the videos in this resource, this should be viewed through the lens of our confidence that a person with sustained undetectable levels of HIV in blood cannot transmit HIV to their sexual partner, making the decision to conceive much more natural.

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