HIV and pregnancy

Pregnant women do not need to take an anti-HIV drug intravenously (through a drip) during labour and delivery as long as their viral load is undetectable and there are no problems with the delivery, French research shows.

But for women who have a high viral load, the intravenous drug does reduce the risk of the baby becoming HIV positive.

HIV can be passed on from mother to child, but effective HIV treatment can reduce this risk to well below 1%. Mothers are asked to take combination treatment in tablets during pregnancy; some mothers also take one drug (called AZT) intravenously during labour and delivery; and newborn babies are usually given a syrup containing HIV treatment for four weeks after they are born.

But as more mothers now have an undetectable viral load by the time they give birth, doctors have questioned whether the intravenous drug is always necessary. In the last few years, guidelines in the UK, US, France and other countries have stopped recommending it when viral load is low.

Now a study has confirmed that this was the right choice. The researchers looked at the outcomes of over 11,000 pregnancies in France.

Among women with well-controlled viral loads at the time of birth, there were hardly any HIV transmissions, and taking the intravenous drug did not lower the risk any further.

But among women whose viral load was above 1000 copies/ml, it was useful. In this group, 7.5% of women who did not take the intravenous drug passed HIV onto their baby, compared to 2.9% of those who did take it.

More encouragingly, the researchers found that if the intravenous drug wasn’t taken by a woman with high viral load (this may happen if she arrives at the hospital in advanced labour), the risk of HIV transmission could be lowered by giving the baby a stronger combination of drugs for the first month.

The authors say that women with a low viral load do not need to take intravenous AZT during childbirth, unless the delivery may be complicated – for example, because it’s happening early (before 37 weeks), if her waters broke early, or because of fever or bleeding.

For more information you may find our online HIV & pregnancy tool useful: www.aidsmap.com/pregnancy

HIV, age and the kidneys

Kidney function deteriorates more rapidly in older people with HIV than in HIV-negative people, according to a new study. The greatest declines were seen in older people who were not taking HIV treatment.

Improvements in HIV treatment and care and a high rate of new infections mean that more and more people with HIV are in their fifties or sixties. As a result, the diseases of ageing are an increasingly important cause of serious illness and death in people with HIV.

It is well known that kidney function declines with age. And an increased risk of kidney (renal) failure for people with HIV has been associated with a low CD4 cell count, a high viral load and treatment with some antiretroviral drugs.

Researchers from the Chelsea & Westminster Hospital in London examined data from over 15,000 HIV-positive patients. Most were white gay men, but the proportion over the age of 50 increased from 11 to 23% between 1996 and 2011.

As expected, kidney function declined with age, but it was always lower than reported in studies of people who do not have HIV. People with HIV over 70 years of age were at greatest risk of kidney failure, especially if they had never taken HIV treatment. The risk was also elevated in the over-50s.

Damage to the immune system, as measured by the lowest CD4 count that a person had ever had (known as the ‘nadir’ CD4 count), was a strong predictor of kidney problems. People whose nadir CD4 count was below 100 cells/mm³ had eleven times the risk of renal failure than people with a nadir of 350 cells/mm³; people with a nadir between 200 and 300 cells/mm³ had twice the risk.

The doctors say that these results provide another argument for starting HIV treatment soon after a person is diagnosed with HIV – in order to protect the kidneys.

British treatment guidelines already recommend that people with kidney disease that is caused by HIV or with highly advanced kidney disease start HIV treatment as soon as possible.

For an introduction to HIV and the kidneys, read our online factsheet, The kidneys, or browse our topics page on Kidney problems.