HIV Medicines During Pregnancy and Childbirth
Key Points
- HIV medicines (known as antiretrovirals) should be started as soon as possible during pregnancy and/or continued throughout pregnancy to maintain good health, prevent perinatal transmission of HIV, and prevent HIV transmission to sexual partners.
- Because most HIV medicines are considered safe during pregnancy, treatment regimens generally do not change. Rarely, certain HIV medicines are not recommended if the risk of known side effects outweighs the benefits of a treatment regimen.
- After labor and delivery, HIV medicines should be continued. Infants exposed to HIV during pregnancy and childbirth should receive HIV medicines after birth, but the medicines infants receive depend on other factors, including breastfeeding.
- A scheduled cesarean delivery is recommended to prevent perinatal transmission of HIV when HIV viral load is high or unknown near the time of delivery.
Should you take HIV medicines during pregnancy?
Yes, HIV medicines should be used throughout pregnancy to preserve immune function, prevent perinatal transmission of HIV to the baby, and prevent HIV transmission to sexual partners.
HIV medicines (or antiretrovirals), when taken as prescribed, prevent HIV from multiplying and reduce the amount of HIV in the body (called the viral load). The goal is to achieve an undetectable viral load, which occurs when the level of HIV in the blood is too low to be detected by a viral load test.
The likelihood of perinatal transmission of HIV during pregnancy and childbirth is lowest when the viral load is undetectable. Maintaining an undetectable viral load also helps keep the mother healthy.
Are HIV medicines safe to use during pregnancy?
Most HIV medicines are safe to use during pregnancy. Safety data for HIV medicines are collected and monitored over time in the Antiretroviral Pregnancy Registry. In general, data show that HIV medicines do not increase the risk of birth defects.
When recommending HIV medicines to use during pregnancy, health care providers consider the benefits and risks of specific HIV medicines for pregnant women and their unborn babies. Although HIV medicines typically are considered safe during pregnancy, some medicines may not be recommended due to limited safety data.
What HIV medicines should be used during pregnancy?
The choice of HIV treatment regimen during pregnancy depends on several factors, including current or past use of HIV medicines, other medical conditions in addition to HIV (such as heart disease or diabetes), and the results of drug-resistance testing.
In general, the same HIV treatment regimens recommended for nonpregnant adults can be used during pregnancy—unless the risk of any known side effects to a mother or baby outweighs the benefits of a treatment regimen.
Most of the HIV medicines recommended in treatment regimens for nonpregnant adults have well-documented safety data during pregnancy. For example, emtricitabine and tenofovir alafenamide are key components of multiple treatment regimens, and data suggest that these medicines are safe to use during pregnancy.
Sometimes, a person’s HIV treatment regimen may change during pregnancy. For example, data show that darunavir is less effective in controlling HIV during pregnancy. As a result, a health care provider may recommend switching to a new treatment regimen to avoid darunavir, although there is no evidence that darunavir is dangerous.
Health care providers and patients should discuss whether to change an HIV treatment regimen during pregnancy.
When should HIV medicines be started during pregnancy?
HIV medicines should be started as soon as possible during pregnancy and should not be delayed due to concerns about birth defects.
In most cases, an effective HIV treatment regimen that is used before pregnancy should be continued throughout pregnancy. Some HIV medicines are not recommended for use during pregnancy and may need to be changed.
A health care provider should determine whether changes to the medicines or doses in a treatment regimen are necessary before or during pregnancy.
Should HIV medicines be used before and during childbirth?
Yes, HIV medicines should be continued throughout pregnancy and childbirth to prevent perinatal HIV transmission, especially near delivery. HIV medicines reduce the mother’s HIV viral load to undetectable levels, making perinatal transmission of HIV unlikely during childbirth.
When HIV medicines aren’t used or are discontinued during pregnancy, the HIV viral load will most likely be higher, and the chances of HIV transmission from blood and other fluids in the birth canal become significantly higher.
HIV medicines should be taken on schedule as much as possible throughout labor and childbirth.
Should HIV medicines be continued after childbirth?
During pregnancy, prenatal HIV care includes counseling on the benefits of continuing HIV medicines after childbirth. HIV medicines help people with HIV live long, healthy lives and reduce the likelihood of HIV transmission.
Health care providers can help make informed decisions about continuing or changing HIV medicines after childbirth.
In addition, babies exposed to HIV during pregnancy and childbirth receive HIV medicine after birth to reduce the likelihood of perinatal HIV transmission. Several factors, including any ongoing chances of HIV transmission through breastfeeding, determine what HIV medicine babies receive and for how long.
How else do HIV medicines affect childbirth?
A high viral load can occur when HIV medicines are not working effectively or are not taken consistently. When the HIV viral load is high (greater than 1,000 copies/mL) or unknown within four weeks of delivery, a cesarean delivery (also called a C-section) may be scheduled before the expected due date to prevent perinatal HIV transmission.
In contrast, a scheduled cesarean delivery is not recommended solely to prevent perinatal HIV transmission when HIV medicines are effectively controlling viral load. There are other medical reasons to perform a cesarean delivery, regardless of viral load.
Health care providers can help determine which HIV medicines to use before and during childbirth. Providers also can explain whether they would recommend a cesarean delivery to prevent perinatal transmission of HIV based on your personal situation.
Read the HIVinfo Preventing Perinatal Transmission of HIV After Birth fact sheet to learn more.
This fact sheet is based on information from the following sources:
From the HIV Clinical Practice Guidelines at Clinicalinfo.HIV.gov:
- Recommendations for the Use of Antiretroviral Drugs During Pregnancy and Interventions to Reduce Perinatal HIV Transmission in the United States:
- What's New in the Guidelines
- General Principles Regarding Use of Antiretroviral Drugs During Pregnancy: Teratogenicity
- Recommendations for Use of Antiretroviral Drugs During Pregnancy: Overview
- Intrapartum HIV Care
- Care of Infants With Perinatal Exposure to HIV: Antiretroviral Management of Infants With In Utero, Intrapartum, or Breastfeeding Exposure to HIV
- Table 14. Antiretroviral Drug Use in Pregnancy: Pharmacokinetic and Toxicity Data in Human Pregnancy and Recommendations for Use in Pregnancy
Also see the HIV Source collection of HIV links and resources.