Key points
- People living with HIV can give birth without passing on HIV to their baby.
- Your options for conception will depend on your health and your partner’s HIV status.
- Your doctor will recommend you start anti-HIV treatment during your pregnancy if you are not already taking it.
- Your viral load may affect some of your conception and birth delivery options.
People living with HIV can give birth to HIV-negative babies. Most of the advice for people with HIV is the same as it would be for anyone else thinking about having a baby. However, some extra steps are necessary to reduce the likelihood of HIV being passed on.
This page takes you through the things to consider when having a baby in the UK. It’s important to keep your healthcare team informed so that you can receive advice that will work for you.
When a person is pregnant and taking HIV treatment, and they have an undetectable viral load, the risk of HIV being passed on to their baby is just 0.1% (or one in a thousand). Between 2015 and 2016 in the UK, only 0.3% of people with HIV (including people with a higher viral load) passed on HIV to their babies.
When you’re thinking about conceiving, the advice you receive will depend on your individual circumstances. Advice will be based on:
- your general health
- whether you are taking anti-HIV medication
- your viral load
- whether your partner has HIV.
If you are not already taking anti-HIV medication, you will be advised to do so. HIV can be passed on during pregnancy and birth; having an undetectable viral load will help to prevent this.
If you are planning on getting pregnant and are already taking anti-HIV medication, talk to your healthcare team. They will help you understand if your current medication is still the best option during pregnancy. In the UK, if your current anti-HIV medication is effective you will probably be advised to keep on taking it.
There’s some evidence that women with HIV find it harder to become pregnant. HIV can affect your body’s ability to produce the hormones oestrogen and progesterone. This can affect your fertility or lead to an early menopause, meaning you are unable to get pregnant naturally, particularly if your CD4 cell counts are low.
If you are not pregnant after six months of trying, talk to your doctor for advice.
How can we conceive if one of us is HIV negative and one is living with HIV?
When a person living with HIV has an undetectable viral load, there is no risk of HIV transmission during sex. If the partner living with HIV has an undetectable viral load and neither of you have any sexually transmitted infections (STIs), sex without a condom is fine.
If you or your partner have a detectable viral load, it is important to discuss conception options that reduce or remove the risk of transmission. Before deciding not to use condoms, get advice from your HIV healthcare team. They can confirm what would work best for you. This may include the HIV-negative partner taking PrEP. This medication reduces HIV transmission and is safe to take during pregnancy and breastfeeding.
Everyone planning a pregnancy, whether or not they have HIV, is advised to take a daily folic acid supplement. The advice is to take it whilst trying to conceive and for the first 12 weeks of pregnancy. This is because folic acid (vitamin B9) helps cells in the body to develop. It is difficult to get enough through diet alone. You may need to take a higher dose of folic acid with some HIV medications. Speak to your healthcare team about what dose of folic acid would be right for you.
If you are taking a drug called cotrimoxazole (Septrin), you may need to take an increased dose if you are also taking folic acid.
HIV treatment during pregnancy
All pregnant people living with HIV are advised to start taking medication by week 24 of pregnancy if they aren’t already. This is because an undetectable viral load helps to prevent transmission during conception, pregnancy, and birth.
Your birth plan
If you have an undetectable viral load at week 36 of pregnancy, the options for delivery are the same as anyone who does not have HIV. If there are no other considerations, then having a vaginal birth is an option for you. You will be advised to give birth in a facility that can provide the right tests and treatment for your child, such as a birth centre or obstetric centre.
If your viral load is high (over 1000 copies), your doctor will likely recommend a planned caesarean delivery. A caesarean section (also known as a C-section) is an operation to deliver a baby that involves making a cut in your stomach and womb. This prevents contact with blood and other fluids that a baby may come into contact with during a vaginal birth. A caesarean reduces the risk of passing on HIV.
You might also have a caesarean for other medical reasons, regardless of your viral load.
Medication for your baby
Your baby will need to take anti-HIV medication for a period of time after birth. This medication comes as a liquid. This does not mean that your baby has HIV.
The length of time your baby will need to take medication will depend on your viral load. If you are undetectable throughout pregnancy, your baby will be given medication for two weeks. If you are detectable, this may be extended to four weeks.
Testing your baby for HIV
In the early years of your baby’s life, HIV tests will be done several times:
- just after birth (before leaving hospital)
- at six weeks
- at 12 weeks
- at 22-24 months (this is the final HIV antibody test).
Your baby will also be tested at two weeks if there is a higher risk that HIV has been passed on.
If these tests are negative and you have never breastfed, you will know for sure that your baby does not have HIV.
If you are breastfeeding your baby then they will be tested for HIV more often. This includes tests when they are two weeks old and then every month for the whole time you are breastfeeding. Your baby will also be tested four and eight weeks after you finish breastfeeding. If you breastfeed for longer than two years, your baby should have their final antibody test at least eight weeks after you stop breastfeeding.
Feeding your baby
In the UK (as with other high-resourced countries) it is advised not to breastfeed your baby. The best way to ensure that HIV is not transmitted is to formula feed, as there is no risk of HIV being passed on.
Although HIV is an important factor to consider, it is not the only one. You may consider breastfeeding for other reasons. If you do consider breastfeeding, it is important that you have an undetectable viral load and stay in regular contact with your healthcare team. Before breastfeeding, it is important to discuss this with them. It is important that you stop breastfeeding if any of the following occur:
- your HIV becomes detectable
- you or your baby have tummy problems
- your breasts and/or nipples show signs of infection (cracked, sore or bleeding nipples).
This will help to reduce HIV transmission during breastfeeding. However, the most effective way to remove all risk is to not breastfeed.
If you’re advised not to breastfeed you might be able to access free formula milk for your baby. Your HIV clinic should be able to give you more information about this.
You can read more about infant feeding choices on another page.
Your journey to having a baby will be unique to you. It is important that you get the best support and medical care for you and your baby. Staying in touch with your healthcare team will support you in achieving this.