For individuals living with HIV, questions about having healthy, HIV-negative children are common. With significant advancements in medical science and HIV treatment, it is now possible for individuals with HIV to have healthy babies without transmitting the virus.
Pathways to a Healthy Pregnancy
Preventing HIV transmission from a parent to their child begins well before birth, primarily through the consistent use of antiretroviral therapy (ART). ART involves taking a combination of medicines that reduce the amount of HIV in the body, known as the viral load.
When ART is taken as prescribed, the viral load can become so low that standard tests cannot detect it, a state referred to as an “undetectable viral load.” This concept is often summarized by “Undetectable = Untransmittable” (U=U). In the context of pregnancy, maintaining an undetectable viral load substantially reduces the risk of transmitting HIV to the baby to less than one percent, or even as low as 0.1%. Without intervention, the risk of transmission can be as high as 15% to 40%.
Early diagnosis of HIV and consistent prenatal care are also important for a healthy pregnancy. Healthcare providers specializing in HIV and pregnancy work closely with expectant parents to monitor their health and viral load throughout the pregnancy. Starting ART as early as possible in pregnancy, or even before conception, significantly increases its effectiveness in preventing transmission.
Ensuring a Safe Birth and Early Infancy
Medical protocols at the time of birth and immediately afterward further reduce the chance of HIV transmission to the infant. The method of delivery, whether vaginal or by C-section, depends on the parent’s viral load leading up to the birth. For individuals who have maintained an undetectable viral load (typically below 50 copies/mL or 1,000 copies/mL) near term, a vaginal delivery is generally considered safe.
If the viral load is detectable (above 1,000 copies/mL) or unknown near delivery, a planned C-section may be recommended to avoid the baby’s exposure to blood and fluids during a vaginal birth, which could increase transmission risk. After birth, all babies born to mothers with HIV receive antiretroviral medicines, known as prophylactic ART, as soon as possible, ideally within six hours of delivery.
This short course of medication protects the newborn from any potential exposure to the virus during pregnancy or birth. Regarding infant feeding, where safe alternatives are available, formula feeding is often recommended to eliminate any risk of HIV transmission through breast milk. While ART can reduce the risk of transmission through breastfeeding to less than 1%, the risk is not completely eliminated.
However, recent guidelines emphasize shared decision-making, acknowledging that breastfeeding can be considered for parents with consistently suppressed viral loads, with appropriate support and monitoring. Newborns are also tested for HIV after birth, typically using highly sensitive nucleic acid tests (NATs). Initial testing often occurs within 48 hours of birth, followed by tests at 14 to 21 days, one to two months, and again at four to six months of age. These multiple tests ensure accurate detection and confirm the baby’s HIV status.
Life Beyond Infancy: Support and Well-being
When prevention strategies are successfully implemented, a child born to a parent with HIV will be HIV-negative and can expect to lead a healthy life without the virus. This positive outcome allows families to focus on the child’s overall growth and development, just like any other child. The continued health of the parent living with HIV is also an important aspect of family well-being.
Ongoing medical care for the parent, including consistent adherence to ART, ensures their health and helps maintain an undetectable viral load, which prevents further transmission. Beyond medical care, various support networks, counseling services, and community resources are available for families affected by HIV. These resources offer emotional support, practical assistance, and connect families with others who share similar experiences.