Pregnant women living with the Human Immunodeficiency Virus who are on Antiretroviral Therapy and have a low or undetectable viral load can have a vaginal delivery, says the National Agency for the Control of AIDS.
Although HIV can pass to the infant during birth, NACA, however, said the risk of transmission is low in women with virally suppressed loads.
The agency noted that the advances in HIV treatment have greatly lowered the chances that a birthing parent would pass HIV on to their baby (also known as perinatal HIV transmission, vertical transmission, and sometimes called ‘mother-to-child’ transmission).
According to NACA, Nigeria has the highest burden of children born with HIV in the world.
It, however, warned that HIV can be transmitted from an infected mother to her child during pregnancy, childbirth, and breastfeeding if she is not on treatment.
Speaking in an exclusive interview with PUNCH Healthwise, a Deputy Director, Community Prevention and Care Department, NACA, Dr Yewande Olaifa, said for many years now, pregnant women living with HIV have been giving birth vaginally and not only through caesarean sections.
Olaifa said, “Yes, for over a decade now, vaginally, women can deliver unless it is contraindicated because of obstetrics matters.
“But as long as there is no contraindication, she can deliver per vaginal irrespective of the fact that she is HIV positive.
“What is important is that if she is HIV positive, she is on treatment not only for herself but also for the baby. So if we can bring the viral load down with ART, the probability that she will transmit to the baby is limited.”
The American College of Obstetricians and Gynaecologists also affirms that vaginal delivery is appropriate for HIV-infected pregnant women, who have been maintained on combined antiretroviral therapy and who have viral loads of 1,000 copies/mL or less at or near delivery.
Speaking further, the deputy director said it is also compulsory to test all pregnant women for HIV when they come to for antenatal clinic, stressing that it helps in the prevention of motor-to-child transmission of the disease.
According to the World Health Organisation, without any intervention, the risk of HIV transmission from a mother to her child during pregnancy, labour, delivery, or breastfeeding can be as high as 45 per cent.
As such, the WHO states that the identification of HIV infection should be immediately followed by an offer of linkage to lifelong treatment and care, including support to remain in care and virally suppressed, as well as an offer of partner services.
Nigeria faces a critical challenge in PMTCT of HIV and ensuring access to care for children living with HIV.
According to NACA, its epidemiological estimates indicate that 140, 000 children under 14 are living with HIV as of 2023, with 22,000 new infections and 15,000 AIDS-related deaths in children.
The agency disclosed that current PMTCT and paediatric HIV coverage remain alarmingly low at less than 33 per cent, far short of the 95 per cent target.
Meanwhile, the Joint United Nations Programme on HIV/AIDS established the 95-95-95 targets calling for 95 per cent of all people living with HIV to know their HIV status, 95 per cent of all people with diagnosed HIV infection to receive sustained antiretroviral therapy, and 95 per cent of all people receiving antiretroviral therapy to have viral suppression by 2030.
Olaifa pointed out that ARTs used to treat HIV infection do not affect the pregnancy or the baby, assuring that they are safe.
She, however, noted that if the pregnant woman has a high viral load, the physician may recommend a caesarean birth.
The deputy director emphasised that if pregnant women access antenatal care, those who are HIV positive would be discovered during screening and placed on treatment as well as their babies after delivery.
According to her, when pregnant women living with HIV are on treatment and their babies are placed on treatment immediately after birth, whether by CS or vaginal delivery and they faithfully continued with their ART during breastfeeding, it is likely they will not transmit the infection to their babies.
Olaifa explained, “If we can bring the viral load down with ART, the probability that the woman will transmit to the baby is limited. When she gives birth to the baby, if she can start ART syrup for the baby within 72 hours, it is also additional protection for the baby.
“So, wherever the woman chooses to deliver as long as she is on ART and ART for the baby is commenced within 72 hours of delivery, we are good to go.”
Stressing the importance of placing the baby on treatment, she said, “The only thing she will now do is to make sure that even if she delivers in her home and starts the ART within 72 hours, she will just come six weeks after delivery so that we carry out a test because the baby is now classified as an HIV exposed infant.
“We would now do early infant diagnosis to determine if we have been able to prevent transmission from the mother to the child.”
Olaifa warned that if the baby did not receive treatment within 72 hours of birth, the probability that the ART would be effective is limited.
“The reason is that you have given too much time for the virus to replicate within the baby. So it becomes difficult for the ART to suppress the virus. Also, if the baby is not placed on treatment, the possibility that the baby will be HIV positive is higher”, she added.
The deputy director emphasised that HIV-positive pregnant women must be placed on HIV treatment and encouraged to deliver in health facilities to reduce the burden of mother-to-child transmission of the infection.
She said this will ensure that HIV-positive babies are identified on time and treated.
Olaifa lamented that many babies are born HIV-positive because their mothers had no access to care and were not on treatment before the babies were born.
The 2023 statistics from NACA showed that 1.8 million persons are estimated to be living with HIV in Nigeria, out of which about 1.63 million are already on the lifesaving medication of ART.
HIV medicine is called antiretroviral therapy, or ART. If taken as prescribed, HIV medicine reduces the amount of HIV in the body (viral load) to a very low level, which keeps the immune system working and prevents illness.
This is called viral suppression and is defined as having less than 200 copies of HIV per millilitre of blood. HIV medicine can even make the viral load to become so low that a test cannot detect it, and this is called an undetectable viral load.
The WHO says testing and counselling for HIV should be considered a routine component of the package of care for pregnant women in all antenatal care settings.
The global health body stressed that testing during ANC helps in the prevention of mother-to-child transmission of HIV.
It says the availability of HIV testing at ANC services is responsible for the high level of knowledge of HIV status among women in many countries.
This, WHO says, has allowed women and infants to benefit from ART.
WHO recommends that ART should be initiated in all pregnant women diagnosed with HIV.
“This recommendation is based on evidence that shows that providing ART to all pregnant and breastfeeding women living with HIV improves individual health outcomes, prevents mother-to-child transmission of HIV, and prevents horizontal transmission of HIV from the mother to an uninfected sexual partner,” the global health body stated.
