HIV and pregnancy

What is HIV?  

HIV stands for human immunodeficiency virus. HIV is a virus that attacks the body’s immune system. In a healthy person, the immune system protects the body from infections, cancers and some diseases. Once HIV is in your blood, it controls and kills CD4 cells (also called T cells). These cells help your immune system fight disease. If you have HIV, you’re HIV-positive. If you don’t have it, you’re HIV-negative.

HIV spreads through infected body fluids, like blood, semen and breast milk. It’s a sexually transmitted infection because you can get it by having unprotected sex with someone who’s infected. In the United States, it spreads mainly through unprotected sex or sharing drug needles with an infected person.

HIV is the virus that leads to AIDS. AIDS stands for acquired immune deficiency syndrome. It’s the most severe stage of HIV infection. People with AIDS get sick with diseases that the immune system normally can fight, like pneumonia and certain cancers and infections. It may take months or years for HIV to develop into AIDS.

There’s no cure for HIV, but it can be treated. If you have HIV and get early and regular treatment, you can live nearly as long as someone without HIV. Testing for HIV is important because you may not know you’re infected until you get sick. More than 1.1 million people in the United States have HIV, and about 1 in 4 are women (25 percent).

Treatment for HIV during pregnancy can help protect your baby from infection. If you’re pregnant or thinking about getting pregnant and you have or think you may have HIV, tell your health care provider right way. Early and regular treatment can help you stay healthy and keep your baby safe.

How does HIV spread?

You get HIV by coming in direct contact with body fluids from a person who is infected with HIV. You can’t get HIV from shaking hands or hugging a person who has HIV. You can’t get HIV from contact with objects like dishes, toilet seats or doorknobs touched or used by someone with HIV. HIV doesn’t spread through the air or through mosquito, tick or other insect bites.

Body fluids that can contain HIV include:

• Blood
• Breast milk
• Semen or pre-seminal fluid. Semen contains sperm. Sperm in a man’s semen fertilizes a woman’s egg that begins pregnancy. Ejaculation is when sperm comes out of a man’s penis. Pre-seminal fluid is fluid that the penis sometimes releases before ejaculation.
• Vaginal fluids
• Rectal fluids

In the United States, HIV mainly spreads through:

• Having anal or vaginal sex with someone who has HIV without using a condom or taking medicines to prevent or treat HIV. Most new HIV infections in women come from having vaginal or anal sex with a man who is infected. There’s little to no risk of getting HIV from oral sex, but it’s possible if a man with HIV ejaculates in your mouth.
• Sharing needles, syringes, rinse water or other equipment (works) used with street drugs with someone who has HIV. HIV can live in a needle for up to 42 days.

You’re at increased risk for HIV if you:

• Have sex with more than one partner
• Have sex with partners who use intravenous (also called IV) street drugs. This means they inject street drugs into their body through a needle into a vein.
• Have sex with partners who also have sex with men
• Have another sexually transmitted infection (also called STI, sexually transmitted disease or STD). An STI, like HIV, is an infection you can get from having sex with someone who is infected. Certain STIs can increase your chances of getting HIV.

Less common ways HIV can spread include:

• From mom to baby during pregnancy, labor, birth or breastfeeding
• Being stuck with a needle or other sharp object that’s contaminated with HIV. This risk is mainly for health care workers who may come in contact with infected body fluids.  

In rare cases, HIV has spread through:

• A blood transfusion, blood products or an organ or tissue transplant. A blood transfusion is when you have new blood put into your body. A transplant is an operation in which a surgeon removes a damaged organ or tissue and replaces it with a healthy one from another person. HIV spread through transfusions and transplants was more common in the early years of HIV, but it’s a low risk today because donated blood, organs and tissues are tested for HIV.
• Eating food that’s been chewed by someone with HIV. Some babies have been infected with HIV after eating food that was chewed by an infected caregiver. This can happen when infected blood from a person’s mouth mixes with food while chewing. HIV doesn’t spread through saliva.
• Direct contact with infected body fluid through broken skin, a wound or mucous membranes. A mucous membrane is a thin skin that covers the inside of certain parts of the body, like the vagina, penis, mouth and rectum (where bowel movements leave the body).
• Deep, open-mouthed kissing when both partners have sores or bleeding gums

How can you protect yourself from HIV?

Here’s how to help keep yourself safe from infection:   

• Don’t have sex. Sex includes vaginal, oral and anal sex.
• Limit the number of sex partners you have. Have sex with only one person who doesn’t have other sex partners.
• Use a condom every time you have sex. Condoms are barrier methods of birth control. Barrier methods help prevent pregnancy and STIs by blocking or killing your partner’s sperm. Male latex condoms work best to prevent STIs; other kinds of condoms don’t work as well. Other kinds of birth control, like the pill and implants, don’t protect you from STIs.
• Don’t share needles, syringes, razors or other things that may come in contact with another person’s blood.
• Get tested and treated for HIV and other STIs. Having certain STIs can increase your chances of getting HIV. Ask your partner to get tested and treated for HIV and other STIs.
• If you’re at very high risk for HIV, talk to your provider about treatment called pre-exposure prophylaxis (also called PrEP). You’re at very high risk for HIV if your partner is infected, your partner has more than one sex partner, you have more than one sex partner or you share drug needles or equipment with others. PrEp can help reduce the risk of getting infected with HIV through sex. Using PrEP along with condoms can help reduce the risk of infection even more.  
• If you think you’ve been exposed to HIV within the last 3 days, call your health care provider. Treatment called post-exposure prophylaxis (also called PEP) may help reduce your risk for getting infected, but you have to start taking it within 3 days (72 hours) of your exposure.

How can you help protect your baby from HIV during pregnancy?

Get tested and treated for HIV. If you have HIV, getting treatment before and during pregnancy usually can prevent infection in your baby. If you take HIV medicines throughout pregnancy, labor and birth, and give your baby HIV medicines for 4 to 6 weeks after birth, the risk of passing HIV to your baby can be 1 in 100 (1 percent) or less.

If you have HIV that’s not treated, you can pass it to your baby:

• Before birth through the placenta. The placenta grows in your uterus (womb) and supplies the baby with food and oxygen through the umbilical cord.
• During labor and birth through contact with mom’s blood and vaginal fluids. When you go into labor, your amniotic sac breaks, which increases your baby’s risk of getting infected. The amniotic sac is the sac (bag) inside the uterus that holds a growing baby. It's filled with amniotic fluid. Most babies who get HIV from their moms get infected around the time of birth.
• After birth through breast milk. If you have HIV, don’t breastfeed your baby.

The Centers for Disease Control and Prevention (also called CDC) recommends that all women who are pregnant or planning to get pregnant get an HIV test as early as possible before and during every pregnancy. The earlier HIV is diagnosed and treated, the better HIV medicines work to protect your health and prevent infection in your baby. HIV is treated with a combination of medicines called antiretroviral treatment (also called ART). ART can help reduce the amount of HIV in your body (also called viral load) and keep your immune system stronger. Taking ART the right way every day can keep your viral load low and help reduce the risk of passing HIV to your baby during pregnancy.

If you don’t have HIV and your partner does:

• Ask your provider about PrEP. Taking PrEP every day while trying to get pregnant, during pregnancy and while you’re breastfeeding helps protect you and your baby from HIV.
• Ask your partner to take ART to help reduce the risk of passing HIV to you.
• If you think you’ve been exposed to HIV within the past 3 days, ask your provider about PEP.

If you’re pregnant and have HIV: The CDC recommends that you get tested as early as possible and again later in pregnancy if you do things that put you at high risk for HIV, like having more than one sex partner or you share drug needles. If you haven’t had an HIV test during pregnancy, you can get a quick test during labor and birth. If this test shows you have HIV, you can still get treatment to help protect your baby from infection.

During pregnancy, get early and regular prenatal care (medical care you get during pregnancy). Your provider checks your viral load and CD4 cell count throughout pregnancy. If you have a high viral load or a low CD4 count, you’re more likely to get sick and pass HIV to your baby. Even if you have a low viral load, you can still pass HIV to your baby. If you’re being treated for HIV during pregnancy, here are some things you can do to help keep your baby safe from infection:   

• Take your HIV medicine exactly as your provider says.
• If you’re thinking about having have certain prenatal tests, like amniocentesis (also called amnio) or chorionic villus sampling (also called CVS), ask your provider about the risk to your baby. Amnio and CVS are used to diagnose certain birth defects and genetic conditions in your baby. Having these tests may increase your baby’s risk for infection.
• Talk to your provider about cesarean birth (also called c-section). If you have high or unknown levels of HIV in your body, a c-section can help reduce the chances of your baby getting infected. A c-section is surgery in which your baby is born through a cut that your doctor makes in your belly and uterus. If you have HIV and your CD4 cell count is low, your c-section incision (cut) may heal slowly and you’re more likely to get an infection. Your provider can give you medicine to help prevent infection during surgery.
• Be sure that your baby gets treated for HIV after birth. This helps reduce your baby’s chances of getting infected from HIV during birth. Your baby gets tested for HIV for a few months after birth. If she has HIV, early treatment is important because HIV can advance faster in children than adults. Early treatment can help children with HIV live longer, healthier lives.
• Don’t breastfeed your baby.
• Once your baby’s eating solid food, don’t chew it before giving it to him.

If you have HIV and you’re not ready to get pregnant:

• When you have sex, use condoms and a second form of birth control at the same time to help reduce your risk of getting an STI or passing HIV to your partner during sex.
• Talk to your health care provider about birth control to help keep you from getting pregnant until you’re ready. Birth control helps keep you from getting pregnant. Some HIV medicines and some kinds of hormonal birth control may not work well together. Hormonal methods of birth control contain hormones that prevent you from releasing an egg so you can’t get pregnant. Hormonal methods include implants, non-copper intrauterine devices (also called IUDs), the pill and the patch. If your partner doesn’t have HIV, don’t use birth control called spermicide. Spermicide kills sperm. It comes as foam, gel, cream, film and suppositories (tablets that dissolve after you put them in your vagina). Spermicide increases the risk of passing HIV to your partner.  

Where can you get tested for HIV?

You can get an HIV test from:

• Your health care provider. As part of your prenatal care (medical care you get during pregnancy), your provider tests your blood for infections, like HIV and other STIs, that can affect your pregnancy.
• Hospitals
• Clinics, AIDS services organizations, substance abuse programs and community health centers
• Some pharmacies

To find a testing site near you:

• Call 1-800-CDC-INFO (232-4636).
• Visit: gettested.cdc.gov
• Text your ZIP code to KNOW IT (566948).
• Contact your local health department for more information.

You also can test yourself for HIV. The U.S. Food and Drug Administration (also called FDA) has approved two HIV tests you can do on your own:

1. Home Access HIV-1 Test System. You prick your finger for a blood sample, send it to a lab for testing and call the lab for results. If the test result is positive for HIV, the lab does a follow-up test on the same blood sample to confirm the result.
2. OraQuick In-Home HIV Test. You use a test stick to swab your gums to get a sample of mouth fluids and put the test stick in a test tube filled with a testing solution. You get results in 20 minutes. A positive result always needs to be confirmed by an HIV test done in a health care setting, like your provider’s office.

The companies that make home HIV tests can connect you with counselors who can answer questions about follow-up testing or treatment. See the information that comes with your home test to find out how to contact a counselor.

Are HIV test results private?

Your HIV results can be:

• Confidential. This means your HIV test results include your name and other information, but only people allowed to see your medical records can see the results. Most HIV tests are confidential. HIV-positive test results are reported to state or local health departments to be included in HIV statistics, but health departments remove all personal information (like your name and address) before they share test information with the CDC. The CDC uses the information only for reporting reasons and doesn’t share it with any other organizations.
• Anonymous. This means you don’t have to give your name when you take an HIV test, and only you know the test results. Both home HIV tests are anonymous. If you take Home Access HIV-1 test, you get a number. To get your test results, you call the lab and give the number instead of your name. Some public HIV test sites offer anonymous testing.

Talk to your health care provider or contact your local health department or other test sites to learn more about your testing choices.

If you have HIV, does your baby need special medical care after birth?

Yes. If you have HIV, your baby gets a medicine called zidovudine (brand name Retrovir®) within 6 to 12 hours after birth to protect her from any HIV that may have passed to her during birth. A baby usually gets zidovudine for 4 to 6 weeks after birth. Then your baby gets medicine called sulfamethoxazole/trimethoprim (brand names Bactrim® and Septra®) to help prevent Pneumocystis jiroveci pneumonia (also called PCP). PCP is common in people with HIV. If your baby’s HIV tests show she doesn’t have HIV, this treatment stops. If testing shows that your baby has HIV, she starts ART.

Your baby gets a blood test for HIV at:

• 2 to 3 weeks after birth
• 1 to 2 months of age
• 4 to 6 months of age

You need results from at least 2 blood tests to know for sure if your baby has HIV:

• To know that your baby doesn’t have HIV, results from two tests must be negative. The first negative result has to be from a test done when your baby is 1 month or older. The second result has to be from a test done when your baby is 4 months or older.
• To know that your baby has HIV, results from two blood tests must be positive.

Most babies with HIV can get all routine childhood vaccinations. Vaccinations are shots that contain vaccines (medicine) that help protect your baby from certain diseases. Some babies with HIV shouldn’t get live-virus vaccines, like the chickenpox vaccine or the measles-mumps-rubella vaccine (also called MMR). Talk to your baby’s provider to find out which vaccines are safe for your baby.

What are the signs and symptoms of HIV?

Signs of a condition are things someone else can see or know about you, like you have a rash or you’re coughing. Symptoms are things you feel yourself that others can’t see, like having a sore throat or feeling dizzy. The signs and symptoms of HIV vary depending on your health and the stage of your infection. Signs and symptoms may last for a few days to several weeks. Some people with HIV don’t have signs or symptoms for 10 years or more.

If you think you may have HIV, even if you don’t have signs or symptoms, tell your provider. Getting tested and treated can help you stay healthier longer and reduce your chances of passing the infection to others.

HIV has three stages of infection that have different signs and symptoms:

Stage 1: Acute infection. This is the first 6 months of infection. About 4 to 9 in 10 people with HIV (40 to 90 percent) have signs or symptoms of flu within 2 to 4 weeks after infection. During this stage, you have a large amount of HIV in your blood and are very contagious. Flu-like signs and symptoms of acute HIV infection may include:

• Fatigue (feeling very tired)
• Fever, chills or sweating at night (also called night sweats)
• Enlarged lymph nodes (swollen glands in the neck and groin)
• Mouth ulcers (sores) or sore throat
• Muscle aches
• Rash

Stage 2: Clinical latency (also called HIV inactivity or dormancy). During this stage, HIV is still active in the body, but it’s spreading at low levels. You may not get sick or have signs or symptoms. If you take ART the right away every day, you may stay in this stage for several decades. At the end of this stage, your viral load starts to increase and your CD4 count starts to decrease. As this happens, you may begin to have flu-like signs or symptoms as HIV levels rise in your body.

Stage 3: AIDS. People with AIDS have extremely weak immune systems and get more and more severe illnesses (also called opportunistic infections or OIs). You have AIDS when your CD4 count drops below 200 cells/millimeter or if you develops certain OIs. If you have AIDS, you can have a high viral load and easily spread HIV to others. Signs and symptoms of AIDS include:

Changes in your body:

• Diarrhea that lasts for more than a week
• Fever that keeps coming back or heavy night sweats
• Red, brown, pink or purplish blotches on or under the skin inside the mouth, nose or eyelids
• Sores in the mouth, anus or genitals
• Swollen lymph glands in the armpits, groin or neck
• Quick weight loss

Changes in how you feel:

• Fatigue (extreme tiredness) for unknown reasons
• Depression. Depression (also called major depression) is a medical condition in which strong feelings of sadness last for a long time and interfere with your daily life. It needs treatment to get better.
• Memory loss
• Neurologic disorders. These are conditions that affect your nervous system. The nervous system is made up of the brain, spinal cord and nerves. It helps you move, think and feel.

OIs that can affect pregnancy include:

• Cytomegalovirus (also called CMV). This is a common infection in young children. Usually it’s harmless. But if you’re pregnant and pass it to your baby, it can cause serious problems.
• Invasive cervical cancer. Cervical cancer is cancer of the cervix, the opening to the uterus (womb) that sits at the top of the vagina. Invasive means the cancer has spread from the cervix to other parts of the body. Cervical cancer is caused by a group of viruses called human papillomavirus (also called HPV). HPV is the most common STI in this country.
• Pneumonia, a lung infection
• Salmonellosis, an infection caused by Salmonella bacteria. Salmonellosis is a kind of food poisoning. You can get infected by touching an infected animal or by eating foods contaminated with Salmonella.
• Toxoplasmosis, an infection that can affect the brain. You can get toxoplasmosis from eating undercooked meat or touching cat poop. It’s caused by a parasite called Toxoplasma gondii.

More information

•    Centers for Disease Control and Prevention   
•    HIV.gov  

Last reviewed: February, 2018