Q: Both me and my wife are HIV positive. I am taking a combination of staviduian 40 mg+, lamividuian 150 mg+, neverpine 200 mg from the past 2 years. My last CD4 count was 800 and viral load is undetectable. My wife hasn't started medicines because as per our doctor's advice her CD4 count should be below 250 before starting medication. Her last CD4 count was 350 and viral load was 10000. My wife is 14 weeks pregnant. What are the chances of the unborn baby being HIV negative, if we continue with the pregnancy? What steps should we take? Will my wife be treated for HIV or she will be treated for protecting the baby first? What will be the total expense of the treatment including delivery? Will she have a normal delivery or a caesarean?

A:I am glad to learn that you are both taking appropriate care and treatment. First I must tell you that even though both of you are HIV positive, you must continue for your own sakes to take all precautions against reinfecting each other. HIV virus evolves and mutates very rapidly and even if you were both infected from the same strain, over time the virus will have changed to different extent in the two of you. Please practice safer sex and avoid reinfection from each other. Reinfection makes the disease progress faster. You must take the decision whether you both want the pregnancy to carry on or do you wish to terminate it by an abortion. If untreated, there is about a 30%-35% chance that the baby will be HIV positive. Putting your wife on appropriate treatment will greatly reduce the risk of HIV infection of the child and increase the chance that the baby will be free of HIV infection. The currently used treatment for preventing parent to child transmission of HIV is designed only to increase the protection to the unborn child and does not treat the mother's condition. The simplest treatment option is just two doses of nevirapine, one to the mother during labour and one to the child soon after birth. Our current state of knowledge suggests that this does not put the mother at risk of drug resistance against the time when she needs anti-retrovirals. As about 1/3 of the infection is due to breast-milk, if affordable the baby must receive adequate amounts of artificial feeds and should not be breastfed by the mother. (Another less used option is feeding by a foster mother). A part of the infection is also attributed to contact of the baby with maternal blood and secretion during passage in the birth canal. To take care of this, a caesarian section is advisable. The doctor must minimise contact of the baby with maternal blood. As you know, medical termination of pregnancy (abortion) remains an obvious choice. The decision must be based on social and human needs taking all the pros and cons. You have a difficult choice before you, may providence guide you in your choice.