HIV drugs and the baby's health

Will HIV drugs affect the baby?
Have combination therapy and protease inhibitors been linked to prematurity?
Can anti-HIV drugs cause birth defects?
What about mitochondrial toxicity?
What about anaemia?
Will my baby be monitored for these symptoms?

Two kids Some mothers and doctors have been reluctant to use or to prescribe anti-HIV drugs during pregnancy. This is out of concern about unknown effects to the baby.

It is difficult to know if there are any long-term effects.

Today, even children who were first exposed to AZT monotherapy during their mothers’ pregnancy are not older than teenagers.

Children first exposed to combination therapy are not likely to be much older than 10 now.

Careful follow-up of children exposed to AZT has not shown any differences compared with other children.

All children born to HIV-positive women in the UK (and other countries) are also being monitored. This close monitoring will provide important safety information in the future.

Ultimately, it seems clear that the biggest risk to a baby born to a mother with HIV is HIV itself. HIV drugs can prevent this.

Will HIV drugs affect the baby?

These concerns are justifiable. Unfortunately there are no definite answers, although overall the drugs do seem reasonably safe.

Some reports have looked at the risk of prematurity, birth defects and mitochondrial toxicity in babies.

Prematurity

Several studies show a greater risk of prematurity (baby born at less than 37 weeks) and low birth weight for babies born to mothers taking anti-HIV treatment with 3 or more drugs.

A recent British study found an overall rate of 13% (normally the rate is about 6-8%).

This should not be a reason for a mother to avoid treatment in pregnancy, particularly if she needs it for her own health. It is important to be aware of the risks though, discuss them with your healthcare team and make sure that you are receiving the best possible treatment, care and monitoring for yourself and your baby in your situation.

Can anti-HIV drugs cause birth defects?

There have been very few reports of birth defects in babies whose mothers have taken HIV drugs in pregnancy. The only caution at the moment is with the drug ddI, which is not recommended in pregnancy in the UK.

What about mitochondrial toxicity?

Mitochondria are the "energy producing factories" that live within our cells. There have been a small number of reports that the use of 3TC and AZT in pregnancy may be linked to mitochondrial damage in children.

In a large study from America, medical records of over 20,000 HIV-negative children born to HIV-positive mothers were searched for abnormalities associated with mitochondrial damage. The study was designed after reports from France of two deaths of infants exposed to AZT and 3TC and six other cases of mitochondrial toxicity.

This large study failed to show evidence of fatal mitochondrial damage in children exposed to these drugs during their mothers’ pregnancy. This was very reassuring.

In a rare number of cases though, short-term mitochondrial toxicity can be a problem in newborn babies. A very small number of babies have been reported with severe lactic acidosis and anaemia believed to be linked to anti-HIV drugs. All have recovered with appropriate care.

What about anaemia?

Anaemia has been reported in babies born to mothers on HIV medications.

This passes quickly and rarely requires a transfusion.

Will my baby be monitored for these symptoms?

Yes.

Babies born to HIV-positive mothers on treatment will be monitored very carefully.