Opportunistic infections

Vaccine use while pregnant
Treating recurrent genital herpes during pregnancy
HIV and hepatitis coinfection
HIV and TB coinfection

Treatment and prophylaxis for most opportunistic infections (OIs) during pregnancy is broadly similar to that for non-pregnant adults. Only a few drugs are not recommended.

Your healthcare provider should check for OIs as part of your ongoing HIV care, and as your immune system recovers using HAART. You may need to be treated for other infections, especially if you are diagnosed with HIV during pregnancy.

Prophylaxis and treatment of pneumocystis jiroveci pneumonia (PCP), mycobacterium avium complex (MAC) and tuberculosis (TB) infections are recommended if necessary during pregnancy.

Prophylaxis against cytomegalovirus (CMV), candida infections, and invasive fungal infections is not routinely recommended because of drug toxicity. Treatment of very serious infections should not be avoided because of pregnancy.

Vaccine use while pregnant

Prophylaxis and treatment of pneumocystis jiroveci pneumonia (PCP), mycobacterium avium complex (MAC) and tuberculosis (TB) infections are recommended if necessary during pregnancy.

Treating recurrent genital herpes during pregnancy

A large number (about 75%) of women with HIV also have genital herpes. HIV-positive mothers are far more likely to experience an outbreak of herpes during labour than negative mothers. To reduce this risk, prophylaxis treatment for herpes with acyclovir is often recommended.

Herpes is very easily transmitted from mother to child. Even if someone is below detection on combination therapy, herpes sores contain high levels of HIV. The herpes virus can also be released from the sores during labour. This will put the baby at risk from neonatal herpes and at increased risk of HIV.

Prophylaxis and treatment with acyclovir is safe to use during pregnancy

HIV and hepatitis coinfection

How easy is it to transmit hepatitis C from mother to baby?

If you are coinfected with hepatitis C virus (HCV) and HIV you may discover this through routine screening in pregnancy there is a risk of transmission of HCV of up to 15%.

Treating your HIV will reduce this risk of transmitting HCV.
BHIVA guidelines recommend a planned C-section delivery for women with hepatis C coinfection.

What about hepatitis B?

It is very likely that mothers with active hepatitis B virus (HBV) will transmit this to their babies the risk of transmission of HBV is 90%.

Transmission can be prevented by immunising the baby against HBV shortly after he or she is born. This is standard practice in the UK.
It may be appropriate for the mother's combination to include HIV drugs that also work against HBV, in particular 3TC and tenofovir.

HIV and TB coinfection

It is important to treat TB in pregnancy. HIV/TB coinfection increases the risk of mother-to-child- transmission of both infections. TB can also increase the risk of the less common in utero (in the womb rather than during labour) mother-to-child transmission of HIV.

Like HIV, TB is a much greater risk to a pregnant woman and her infant than its treatment or prophylaxis.
Most first-line TB drugs are safe to use in pregnancy . The TB drug streptomycin is not recommended in pregnancy as it can cause permanent deafness in the baby.