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Starting a family when you have HIV

If you are living with HIV and thinking about having children, you can. With proper care and medication, people living with HIV can have healthy pregnancies and children, without passing HIV to a partner or child.

“We’ve come to a place where we have some really wonderful drugs and medical advances that past advocates have fought to get us,” says Monica Hahn, MD, an HIV specialist and associate clinical professor of family and community medicine at the UCSF. Medicine School.

“Now, if you can take your medicine regularly, you can have a normal, healthy pregnancy, delivery and baby – a baby without HIV,” she says. “We can basically guarantee that.”

If you are planning to get pregnant and you and/or your partner have HIV, talk to your HIV doctor to make sure your treatment is on the right track. And if you do become pregnant, tell your HIV doctor right away. This is part of the guarantee that you and your baby will be healthy.

Undetectable = Untransmittable

If you have an HIV-free partner, conceiving without fear of transmitting HIV used to be complicated, often requiring intrauterine insemination and fertility treatments.

Today, HIV experts follow a concept called “U=U”, which stands for “undetectable = untransmissible”. This means that if you maintain an undetectable viral load, you will not transmit HIV sexually.

Having an undetectable viral load means there is very little HIV in your blood. Taking your antiretroviral drugs daily makes your viral load undetectable.

“This is truly a groundbreaking discovery and a wonderful, liberating advance, knowing that people living with HIV can and should have healthy and enjoyable sex lives and opportunities to build families that they and everyone else deserve. “, says Hahn.

“We know that people living with HIV can absolutely have healthy pregnancies and HIV-free children without using special technologies in addition to continuing to take their HIV medications,” Hahn continues. “The good news I’m telling the patients I care for now is really very different from what we were saying 10 years ago.”

U=U also applies to the transmission of HIV from a pregnant person to their baby — whether they have a consistent undetectable viral load before conception, throughout pregnancy, and at birth, says Judy Levison, MD , professor of obstetrics and gynecology at Baylor College of Physician specializing in HIV and pregnancy. Under these circumstances, “there were no cases of transmission to babies,” she says.

Getting pregnant with a partner

If you are living with HIV and want to get pregnant, the first step is to take your antiretroviral medications regularly and achieve an undetectable viral load. (You have to do this for your own health, and if you’re planning to conceive, you’re also doing this to protect your baby.) Keep your viral load undetectable for 3-6 months, and then you can have sex without a condom safely. of transmitting HIV to your partner, says Levison.

If you have HIV and want your partner to be pregnant with your sperm, the advice is the same: take your meds and achieve a steady undetectable viral load, then go ahead and try to conceive.

If you don’t have HIV but your partner does, ask your doctor if pre-exposure prophylaxis (PrEP) is an option. PrEP is a daily pill that reduces the risk of contracting HIV. PrEP is safe to take during pregnancy and breastfeeding.

Planning for pregnancy and childbirth

Many HIV medications are safe to take during pregnancy, so you will probably be able to continue taking your same medication during your pregnancy. You should have your viral load checked often — every month or two — to make sure it remains undetectable. Sometimes medicines work differently during pregnancy, so your doctor may need to adjust your medicine or dose if your viral load increases.

Labor and delivery for people living with HIV is much the same as for others, Hahn says. You can have a vaginal birth as long as your viral load is below 1000 when you are ready to give birth. If it’s over 1,000, you’ll need a caesarean to reduce the risk of the baby getting HIV during delivery.

After birth, your baby should receive 4 weeks of AZT medicine, which protects him against HIV. They will be tested multiple times: at birth, 2 weeks, 4 weeks and 4 months, Hahn says.

Breastfeeding has never been recommended for people living with HIV – and it is still the official recommendation in the United States, as it has been since 1985.

But many parents want to breastfeed, Levison says. A panel of experts advised the US Department of Health and Human Services (HHS) on this. The panel asserted that breastfeeding is not recommended for people living with HIV as the risk is not zero. But the panel recommended that if a doctor has an HIV-positive patient who wants to breastfeed, he should discuss the risks and benefits with her.

“We can’t say U equals U for breastfeeding, but we can say the risk is very low [for people who have undetectable viral loads]says Levison. If you decide to breastfeed, she says you need to take your meds, have your viral load monitored every 1-2 months, and have your baby tested regularly.

“We just have to say that we can’t give you a 100 percent guarantee that you won’t pass” HIV to your baby through breastfeeding, Levison says. “And then they have to make the decision that’s right for them.”

More ways to have a family

People living with HIV can use any type of fertility treatment, such as in vitro fertilization (IVF) and egg freezing. Sperm used in fertility treatments are systematically ‘washed’ before being used. This process removes HIV from semen.

Fertility clinics can also help you build your family through methods such as donor insemination or surrogate mothers if needed.

Adoption is also an option. It is illegal for adoption agencies to discriminate against people living with HIV under the Americans with Disabilities Act.

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