Dear Doctor,
I am HIV-positive and four months pregnant. I have been on ARVs (Tenofivir, Lamivudine and Efavirenz) since 2008. Can I continue with this combination now that I am pregnant? Is the medication safe for my unborn baby?
Anonymous

Dear Anonymous,
Women living with HIV who get pregnant are advised not to use Efavirenz, one of the commonly used ARVs because this drug sometimes affects the development of the foetus in the first three months of pregnancy.

However, after the first three months also known as the first trimester, Efavirenz can be used. This is because it is during the first three months of pregnancy that different organs of the foetus are formed and after that they just increase in size until the baby is born.

Clinicians should ask questions about pregnancy and/or even do pregnancy tests before prescribing ARVs for HIV positive women. A woman could be pregnant or can conceive even when she is sick.

On the other hand, all women need to be aware of their reproductive cycle and communicate any information they deem necessary to their healthcare providers, even when it is not asked for. When you are living with a life-long illness like HIV, self-management of your condition in collaboration with your health care providers is encouraged. 

Lastly, all women should know their HIV status before they become pregnant or as soon as they realise they are pregnant.

This is the only way we are going to end HIV among children. Now we know that if all HIV-positive pregnant women were counselled and put on ARVs, the risk of them infecting their babies with HIV would be greatly reduced. We should all use this knowledge to stop HIV among children.