Testing for HIV in Pregnancy
This post is a follow-up from a previous blog, here
Hello, Chris again. I’m a sexual health doctor, meaning I spend a lot of time talking to people about HIV testing. However a lot of young mothers haven’t been to sexual health clinics before and thus haven’t had the opportunity to discuss HIV testing. I thought I’d write about the dreaded blood test everyone worries about during their appointment and try and share some information or dispel some myths about what happens and why we do it.
What are HIV and AIDS?
HIV stands for the Human Immunodeficiency Virus and is the virus that can cause AIDS. It is commonly acquired from unprotected sex with an HIV-positive person, or transmitted through bodily fluids like blood, semen and breast milk. HIV infection in heterosexual people is becoming more common in theUKand the number of heterosexually infected people is now higher than the number of gay people with the infection. If you are HIV-positive, it can be passed onto your unborn baby through pregnancy. HIV gradually damages the immune system and, without treatment, can lead to the development of serious infections and disability.
AIDS stands for Acquired Immune Deficiency Syndrome and is a term used for HIV-positive people whose immune system is severely impaired by the HIV virus. Most people with HIV don’t have any symptoms and feel very well so often the only way of picking up the infection is by having a blood test.
There is about a 20-30% risk of transmitting HIV from mother to baby during pregnancy and birth if no treatment is given. There is then a further risk of about 5-20% of transmission through breastfeeding. This can be significantly reduced to less than 1% by identifying the infection and starting treatment during pregnancy. Once the baby is born they are often given a short course of anti-HIV medication to further reduce their risk. The baby will then have blood tests to ensure they haven’t been infected but these may take several months and several repeated tests to be 100% certain. One in five HIV-infected babies develops AIDS or dies within the first year of life, so it’s important to reduce the risk of transmission.
Before having the HIV test it is important to consider a couple of things:
- HIV is treatable, life expectancy is now into the mid 70s if diagnosed young and early diagnosis improves outcome of HIV infection
- Modern drugs are effective at helping the immune system stay healthy, and delay the development of AIDS
- Treatment can help prevent passing the virus on to your baby
- A positive HIV diagnosis may cause concerns about relationships with your partner or friends
- Travel to certain countries may be restricted
- There may be employment issues if working for the health service
- It may be more expensive to take out some insurance policies or mortgages
You have the right to decline the HIV test at antenatal booking and, if so, your care will not be any different from any other expectant mother. You are also able to take time to think about the test in more detail if you wish and have the test at a later date, however the earlier the infection is picked up the better.
What does the test involve?
If you agree to the test your midwife will gain your consent and take a small sample of blood from your arm to send away to the lab for testing followed by a short wait of a few days to a week for the result. Your midwife will liaise with you how best to deliver the results. If the test is negative then it is very unlikely that you have the infection. Like syphilis, there can be a 3 month period after infection before the test becomes positive so repeat tests may be indicated if you have had recent exposure that you are concerned about. Again your midwife will be able to give you more information on this if necessary.
HIV and pregnancy care
If the test comes back positive you’ll be offered specialist care and regular follow up during your pregnancy. This is likely to involve the commencement of anti-HIV medication that has been shown to be safe in pregnancy and regular blood test monitoring. If the medication works as the doctor expects, then you can often still have a natural vaginal birth. If there is still circulating virus in the blood at delivery then a caesarean section is safest to prevent transmission during labour. This is best discussed with your obstetrician and will be decided closer to delivery. After birth, your baby will need a course of anti-HIV medication for a few weeks and you will be advised to bottle-feed, not breastfeed.
If you think that you’re at risk of getting HIV or you know that you’re HIV positive, talk to your midwife or doctor about HIV testing and counselling. Support can be obtained from the following organisations and websites:
The Terence Higgins Trust
Facts and figures
Finally, I’d like to provide some facts and figures to hopefully put your mind at ease:
- National uptake of antenatal screening in 2010 for hepatitis B and HIV was 96% and for syphilis was 97%
- 0.43% of pregnant women screened in 2010 were positive for hepatitis B
- 0.15% of pregnant women screened in 2010 were positive for syphilis
- 0.17% of pregnant women screened in 2010 were positive for HIV
So overall the risk is very low, and well worth considering testing to protect your own health and the health of your baby.
If you have any questions, just check with you midwife or your friendly local GP prior to taking the test. If you aren’t pregnant and want to have a test for any sexually-transmitted infections, it is probably best to arrange an appointment at you local sexual health clinic where they can offer individual advice.
Remember, there is no such thing as a “stupid” or “embarrassing” question to people in our profession and everything you disclose to your midwife or doctor will be kept strictly confidential.
Further advice can be found at:
Facts and figures can be found at: