HIV is a controversial subject in many nations, including Malaysia.
Being diagnosed with the condition is at times considered humiliating. Even if some people become infected without their knowledge.
But before I go any further into this subject in connection to pregnancy, I’d like to shine a light on the importance of HIV awareness.
What Should You Know About HIV?
According to Centres for Disease Control and Prevention (CDC), Human Immunodeficiency Virus (HIV), is a virus that attacks the body’s immune system.
Late diagnosis and if left untreated, HIV may lead to AIDS (acquired immunodeficiency syndrome). AIDS is the final stage of HIV disease and always fatal.
At present, there is no effective cure for HIV/ AIDS.
However, with early diagnosis and treatment with antiretroviral therapy (ART) will likely result in undetectable viral load in the body.
Thus, they can lead long healthy lives and will not transmit HIV to their loved ones.
HIV may spread through contact with infected body fluids such as blood, semen, pre-seminal fluid, rectal fluids, vaginal fluids, and breast milks.
According to the World Health Organisation (WHO), the following behaviours and conditions may increase risk of getting HIV infection::
- having condom-less anal or vaginal sex
- having other sexually transmitted infection (STI) such as syphilis, herpes, chlamydia or gonorrhoea
- engaging in harmful use of alcohol and drugs in the context of sexual behaviour
- sharing contaminated needles, syringes, and other injecting equipment and drug solutions when injecting drugs
- receiving unsafe injections, blood transfusions and tissue transplantation, and procedures that involve unsterile cutting or piercing
- accidental needle stick injuries among healthcare workers
According to The Global AIDS Monitoring Report 2023 by the Ministry of Health Malaysia, sexual transmission has become the main mode of transmission over the last decade in Malaysia.
In addition, more than three quarters of HIV new infections were reported among people aged 20 to 39 years old in the year 2022. 70% of the new patients were diagnosed at a late stage.
Thus, it is necessary to educate especially the young people in Malaysia on knowledge of HIV infection, its preventive measures and testing.
In the first few weeks after being infected, people may not experience symptoms. Others may have flu-like illness including fever, headache, rash, and sore throat. So, you can only know if you have the virus with a HIV test.
Taking the test at a Government Health Clinic before getting married is mandatory for Muslim couples and encouraged/optional for other religions.
For those with high-risk behaviours, they are recommended to do annual HIV testing for early detection.
Unfortunately, there is still a lack of disease knowledge and awareness in our community. Therefore, the finding of a woman being unexpectedly HIV tested positive and pregnant concurrently is not uncommon in our practice.
If An HIV-positive Patient Discovers She’s Pregnant
While detailed information on her social and behaviour risk factors are important to be elicited for best pregnancy outcome to both mother and baby, it is done not to find fault. Other infectious screening such as syphilis and hepatitis B screening would be done as well.
Antiretroviral therapy (ART) is treatment of people infected with human immunodeficiency virus (HIV) using anti-HIV drugs.
In this case, the HIV-positive mother would receive ART medication to reduce risk of transmitting HIV to her unborn child.
Most ART medications are safe to be used in pregnancy and able to reduce the viral load, hence minimising the risk of mother-to-child transmission.
Mother-to-child transmission may occur during pregnancy, while in labour and delivery or during breastfeeding.
Extensive counselling will be done regarding benefits and risk of ART medications before starting her treatment.
Going Through Pregnancy As An HIV-Positive
The expectant HIV woman will be required to be compliant to her ART medications throughout her pregnancy to suppress the virus.
ART medications should be taken as soon as possible once she found out that she was pregnant and continue till delivery.
In real practice, the largest proportion of expectant HIV women had been living with HIV and already on ART at antenatal care booking.
They should keep taking their ART regimen throughout their pregnancies. Being on treatment before, during and throughout pregnancy and birth, minimises risk of mother-to child transmission.
What About During and After Childbirth?
Vaginal delivery is permissible if the viral load level is low.
Caesarean delivery should only be done if the viral load level is significant or if there is obstetric contraindication for vaginal delivery.
Once a baby is born, breastfeeding is best avoided and not recommended.
In Malaysia, all HIV-exposed infants get free antiretroviral (ARV) prophylaxis and free placement feeds for two years.
This practice resulted in prevention of more than 98% mother-to-child transmission in HIV-exposed infants in 2017 compared to 30-40% had there been no intervention (The Global AIDS Monitoring Report 2023, Ministry of Health Malaysia).
Malaysia has been certified as the first country in Western Pacific Region to have eliminated vertical HIV transmission.
All HIV-exposed infants should have HIV testing at birth and at 6 weeks.
The national surveillance system reported 100% of HIV-exposed infants receiving HIV tests within 2 months in 2021 with no new HIV infections among infants born to HIV positive mothers in Malaysia.
Never Be Afraid to Seek Personal Consultation
It is important to take pregnancy seriously when you are HIV positive.
The most crucial part of living with HIV is to be insightful. This includes good compliance to ARVs medicine prescribed, eating healthy and exercising.
For women who have been living with HIV positing and already on ART, preconception counselling with your doctor is important before you embark into pregnancy.
Your doctor will guide you on the following:
- What is the safest way to conceive?
- When is the safest time to conceive?
- Will HIV cause problems for me during pregnancy or delivery?
- Will my HIV treatment cause problems for my baby?
- What are the pros and cons of taking HIV medicine while I am pregnant?
- Is my viral load undetectable?
- How do I avoid transmitting the virus to my partner(s), or my baby during conception, pregnancy, and delivery?
- What medical and community programs and support groups can help me and my baby?
- What birth control methods are best for me?
Final Note: Keep in mind that being HIV positive is not the end of the world. Staying healthy is possible with proper medical attention and medications. Having HIV does not prevent one from having children. So, remember to stay calm. You’ve got this, mummy!
Disclaimer: The information provided in this article is for informational purposes only and should not be considered as medical advice from Motherhood. For any health-related concerns, it is advisable to consult with a qualified healthcare professional or medical practitioner.
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