Modern ART for South Africa

Learn how ART protects both you and your baby from HIV during pregnancy, birth, and breastfeeding.

• Can people living with HIV have children without HIV?

  YES!

  ART protects your baby from HIV during pregnancy, birth and breastfeeding.

  Talk to your nurse or doctor about it.

• Is the treatment the same for pregnant women as for other people living with HIV?

  South African guidelines recommend ART for everyone with HIV, whatever their CD4 count or viral load.

  This includes pregnant women and women who want to get pregnant.

  There are a few more things for women to consider when starting or taking ART.

  We explain these in this booklet.

• The ARV combination in South Africa

  ART is usually three ARVs in one pill – called a fixed-dose combination.

  The combination of ARVs used in South Africa is: tenofovir (TDF), lamivudine (3TC) and dolutegravir (DTG). This is sometimes shortened to TLD.

  For more information about TLD, read the Starting ART leaflet.

• Dolutegravir & pregnancy

  Earlier research suggested that there was a slightly higher rate of neural tube defects (NTDs) than normal in babies whose mothers became pregnant on dolutegravir.

  But more recent findings show no greater risk.

• What is a neural tube defect?

  The neural tube in a developing baby is what becomes the brain, spinal cord, skull and spine.

  The neural tube closes in the first 28 days of pregnancy – that is before most women know they are pregnant.

  If it does not fully close for some reason, the baby is said to have a neural tube defect.

  Neural tube defects vary, from very minor ones that are easily fixed, to ones that cause severe disability and even death.

  So, the risk was taken very seriously by the department of health, health workers and patients.

• Can women living with HIV safely take dolutegravir?

  Yes.

  All women living with HIV should be told their options, to help them select the appropriate ARV combination with their health worker. For most women, this will be a DTG-containing regimen.

• What if I want to become pregnant?

  If you plan to become pregnant, you should be given all the latest information on dolutegravir and pregnancy.

• What if I am already pregnant?

  If you are already pregnant and taking dolutegravir-based ART, you will be recommended to continue doing so.

• What if I do not want to fall pregnant?

  If you do not wish to become pregnant, and you are using effective contraception, you will be recommended the dolutegravir-based combination.

  Effective contraception means a modern method: condoms, oral contraceptives, injectables, implants or IUCD.

• Make sure you are comfortable with your decision

  This is very important!

  It is also important to know that if you decide to have a baby and are taking dolutegravir, and you are concerned about neural tube defects, you can talk to your healthcare team about your concerns.

• Take care of yourself

  Your own health and your own HIV treatment are the most important things to consider for ensuring a healthy baby.

  • You must take your ARVs correctly, every day, to protect your baby from HIV.
  • Your baby must be tested a few times for HIV in the first 18 months, with the last test at 18 months.
  • After your baby is born, you can get a longer supply of ARVs. You can time this with your baby’s testing and immunisations. This will reduce your number of visits to the clinic.

• Understand your options

  Make sure you understand your options – including by looking at information like this leaflet.

  Make sure your health workers discuss your options with you and respect your decision.

• Keep going!

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