Monitoring and other tests

Screening for other infections
Are there any tests I should avoid?

Both pregnancy and HIV care require good monitoring. You will be screened for other infections. You will be recommended to avoid some tests used to monitor the baby during pregnancy and labour.

For HIV you will have your viral load and CD4 count carefully monitored. You may also need a resistance test.

Some doctors may recommend TDM (therapeutic drug monitoring). TDM uses blood tests to check whether you are absorbing the correct amount of a drug. Drug levels, particularly of protease inhibitors vary greatly between individuals and tend to be lower during pregnancy.

Unless you need extra care you will probably visit your clinic monthly for most of your pregnancy and every two weeks after the eighth month.

Screening for other infections

In addition to your HIV care you will be screened for hepatitis, syphilis and other sexually transmitted diseases, anaemia and tuberculosis (TB).

Sexually transmitted diseases and vaginal infections can increase HIV transmission.

You may also need to be screened for toxoplasmosis and cytomegalovirus (CMV). These are two common infections that can be transmitted to your baby. The tests should be performed as early as possible in your pregnancy. You should be treated for these if necessary.

Your clinic will provide a thorough gynaecological check up. This will include a cervical (Pap) smear, which is particularly important if your CD4 is below 200 cells/mm³.

Otherwise, tests will be fairly routine, and may vary slightly from doctor to doctor. Routine tests include blood pressure, weight and blood and urine tests.

Are there any tests I should avoid?

Some tests and procedures commonly used to evaluate mothers and developing babies carry a theoretical risk of increased HIV transmission. However, this risk has not been clearly demonstrated in a study of women taking combination therapy.

HIV-positive pregnant women are generally advised to avoid the following tests unless they are essential:

amniocentesis
chorionic villus sampling
fetal scalp sampling
cordocentis
percutaneous umbilical cord sampling
internal fetal labour monitoring (external ultrasound and fetal monitoring are perfectly OK).

Your healthcare team can explain what these tests are and why it is not recommended to have them.