Table of Contents
Importance of Antiretroviral Therapy During Pregnancy
Antiretroviral therapy plays a pivotal role in managing HIV during pregnancy. It not only reduces the viral load in the mother, thus lowering the risk of perinatal transmission, but also supports the overall health of the mother. Recent studies indicate that when pregnant individuals with HIV adhere to ART, the risk of transmitting the virus to the infant can be reduced to less than 2% (Short et al., 2025). ART regimens typically include a combination of two nucleoside reverse transcriptase inhibitors (NRTIs) and a third agent, such as dolutegravir (DTG) or bictegravir (BIC), which are preferred due to their efficacy and safety profiles (Short et al., 2025).
Antiretroviral Regimens and Safety
The selection of ART regimens during pregnancy should be guided by several factors, including the stage of HIV infection, previous treatment history, and potential drug interactions. Notably, the Antiretroviral Pregnancy Registry has collected data indicating that the use of DTG during pregnancy does not significantly increase the risk of teratogenic effects, as previously thought (Short et al., 2025). Monitoring viral load and CD4 counts is essential to ensure the effectiveness of the regimen and to adapt it as necessary (Short et al., 2025).
Addressing Mental Health Challenges in Pregnant Individuals with HIV
Pregnancy can exacerbate existing mental health conditions and introduce new psychological challenges. Pregnant individuals with HIV may experience increased rates of depression, anxiety, and trauma-related disorders due to the stigma associated with HIV and the stress of pregnancy (Short et al., 2025). Comprehensive care must incorporate mental health support tailored to the unique experiences of these individuals.
Psychosocial Support and Resources
Healthcare providers should facilitate access to mental health resources and support systems. This includes routine screening for mental health conditions, providing counseling, and connecting individuals to support groups. Engaging family members and partners in care discussions can also enhance emotional support and adherence to treatment plans (Short et al., 2025).
Strategies for Preventing Perinatal HIV Transmission
Preventing perinatal HIV transmission is a multi-faceted approach that begins before conception and continues through delivery and postpartum. Key strategies include:
- Preconception Counseling: Discussing the importance of ART adherence before pregnancy to minimize risks.
- Regular Viral Load Monitoring: Ensuring that the viral load remains undetectable throughout pregnancy allows for safer delivery options and reduces the risk of transmission during labor.
- Delivery Options: Vaginal delivery is possible for individuals with well-controlled HIV, while cesarean delivery may be recommended for those with detectable viral loads near term (Short et al., 2025).
Table 1: Recommended HIV Management Strategies During Pregnancy
| Strategy | Description |
|---|---|
| Preconception Counseling | Guidance on ART adherence before conception |
| Viral Load Monitoring | Regular assessments to maintain undetectable levels |
| Delivery Method Selection | Decision-making based on viral load |
| Postpartum Support | Continued care and monitoring for both mother and infant |
The Role of Substance Use in Pregnancy for Individuals Living with HIV
Substance use among pregnant individuals with HIV is a pressing concern that can complicate treatment adherence and health outcomes. Substance use disorders (SUD) can impact ART adherence, increase the risk of adverse neonatal outcomes, and exacerbate mental health issues (Short et al., 2025).
Addressing Substance Use Challenges
Healthcare providers should implement comprehensive screening for substance use and offer appropriate interventions, including counseling, referral to addiction services, and support groups. Collaborating with addiction specialists can also enhance outcomes for pregnant individuals struggling with substance use.
Updated Guidelines for Infant Feeding Practices in HIV-Positive Mothers
Recent guidelines emphasize the importance of individualized infant feeding practices for HIV-positive mothers. While formula feeding eliminates the risk of HIV transmission through breast milk, breastfeeding is now recognized as a viable option for mothers who are on effective ART and maintain an undetectable viral load (Short et al., 2025).
Infant Feeding Recommendations
- Breastfeeding: Encouraged for mothers with consistent viral suppression and ongoing monitoring.
- Formula Feeding: Recommended for mothers with detectable viral loads or those not on ART.
- Mixed Feeding Caution: Not advised due to increased risk of HIV transmission.
Table 2: Infant Feeding Guidelines for HIV-Positive Mothers
| Feeding Option | Recommendations |
|---|---|
| Breastfeeding | Safe for mothers on ART with undetectable viral load |
| Formula Feeding | Recommended for mothers with detectable viral load |
| Mixed Feeding | Not advised due to potential transmission risks |
Frequently Asked Questions (FAQ)
What is the role of ART in preventing perinatal HIV transmission?
ART significantly reduces the viral load in pregnant individuals, thereby minimizing the risk of transmission to the infant during pregnancy, labor, and breastfeeding.
Are there any mental health considerations for pregnant individuals with HIV?
Yes, pregnant individuals with HIV often face increased rates of anxiety, depression, and traumIt is crucial to provide psychosocial support and mental health resources.
Can HIV-positive mothers breastfeed?
Yes, if they are on effective ART and have maintained an undetectable viral load, breastfeeding can be a safe option. However, mothers with detectable viral loads should opt for formula feeding.
What should be monitored during pregnancy for HIV-positive mothers?
Regular monitoring of viral load, CD4 counts, and mental health is essential to ensure the health of both the mother and the infant.
How can substance use disorder impact pregnancy in individuals with HIV?
SUD can complicate treatment adherence, increase the risk of adverse outcomes, and exacerbate mental health issues, making comprehensive care and support essential.
References
- Short, W. R., Lowenthal, E. D., Momplaisir, F., Powis, K. M., Scott, R. K., & Yee, L. M. (2025). HIV and pregnancy: Navigating complex decision making and preventing perinatal transmission. Current HIV/AIDS Reports, 12(4), 1-12. doi:10.1007/s11904-025-00745-0
- Kelesidis, T., Fotooh Abadi, L., Ruedisueli, I., & Middlekauff, H. R. (2025). Atherogenic effects of acute electronic cigarette compared with tobacco cigarette smoking in people living with HIV: A randomized crossover trial. Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, 14(7), e038258. doi:10.1161/JAHA.124.038258
- Omondi, F. H., Harrison, S. Y., & Brumme, Z. L. (2025). Prolonged non-suppressible viremia sustained by a clonally expanded, genomically defective provirus with an immune-evasive HIV protein expression profile. bioRxiv, 2025. doi:10.1101/2025.05.16.654538
- Mutalange, M., Siame, L., Cheelo, C., Masenga, S. K., & Hamooya, B. M. (2025). Kidney impairment in HIV: An insight into the burden and associated factors among adults on antiretroviral therapy in Zambia. A retrospective cross-sectional study. Therapeutic Advances in Infectious Disease, 12, 1-10. doi:10.1177/20499361251340795
- Zash, R., Holmes, L. B., Diseko, M., Jacobson, D. L., Brummel, S., Mayondi, G., … & Shapiro, R. L. (2024). Neural tube defects and major external structural abnormalities by antiretroviral treatment regimen in Botswana. New England Journal of Medicine, 381(9), 827-840. doi:10.1056/NEJMoa1905230
- Cohn, S. E., Umbleja, T., Mrus, J., Bardeguez, A. D., Andersen, J. W., & Chesney, M. A. (2024). Pharmacotherapy and pregnancy: Highlights from the first International Conference for Individualized Pharmacotherapy in Pregnancy. Clinical and Translational Science, 2(1), 11-14. doi:10.1111/j.1752-8062.2009.00079.x
