HIV positive women who become pregnant will need to work closely with their physicians to make decisions about antiretroviral medications. If a woman decides to stop all her medications during pregnancy, her viral load could increase and she could possibly develop AIDS. Continuing or starting antiretrovirals causes concern over the impact on her unborn child. According to The Well Project, without medication, transmission of the HIV virus to an unborn child is 25 to 30 percent. It is important that a woman who is HIV positive have a healthcare provider who will work with her to help her make sound choices regarding her medications.
AZT
According to The Well Project, Zidovudine, or AZT, taken during pregnancy decreases the rate of transmission of the HIV virus to the baby to less than two percent. Women taking HIV medications when they become pregnant, should continue their medications even in the first trimester. At least one of these medications should include AZT. Women, who are not on any medications when they become pregnant, can wait for the first trimester to pass before beginning AZT. During labor and delivery, AZT should be given intravenously to the mother. The baby will need to continue a course of AZT treatment for six weeks after birth.
Viramune
Nevirapine, or Viramune, can be given as a single dose to a woman in labor. The baby will receive one dose during the first three days after birth. According to AIDS.org, the problem with Virumune is the development of resistance in women who use the drug during pregnancy, and in their babies who are breastfed. Once resistance is developed against Viramune, cross-resistance to other drugs in the same class occurs. Viramune is not recommended as first time treatment for HIV positive pregnant women with CD4 counts greater than 250.
Medications to Avoid
Other medications can cause serious harm to the unborn infant. Sustiva (efavirenz) and the combination of Videx (didanosine) and Zerit (stavudine or d4T) are medications that need to be avoided by pregnant women. Sustiva causes severe birth defects such as anencephaly, or being born without a large portion of the brain and skull; unilateral anophthalmia, or being born without an eye; and cleft palate, which is a hole in the upper palate. Fatal lactic acidosis in the mother, which is a fatal buildup of acid in the body, has been reported when using Videx in combination with other retrovirals such as Zerit and Sustiva.
