Human Immunodeficiency Virus (HIV)

Last Update: 01 Jun 2026

Table of content

1. What is it? 2. Why managing? 3. Non-Medical Options 4. Medications 5. Breastfeeding/ chestfeeding 6. Key Takeaways 7. Limits of Research

Welcome to our Fact Sheet on HIV in pregnancy and lactation. The information is based on current research and may evolve with new scientific knowledge. This content does not replace personalized advice your healthcare professionals.

The Healthy Pregnancy Hub collaborates with the expertise of the CIHR Pan-Canadian Network for HIV and STBBI Clinical Trials (CTN+) in developing this information sheet.

CTN+ plays a central role in Canada’s response to HIV and other sexually transmitted and blood-borne infections (STBBIs). Through high-quality research conducted in partnership with communities, the network helps develop evidence-based solutions for people and regions affected by these infections.

1. What is HIV?

Human Immunodeficiency Virus (HIV) is a virus that infects the immune system. It specifically targets white blood cells called CD4 T lymphocytes (helper T cells) which help your body fight infections. However, HIV uses these cells to make copies of itself and gradually weakens your immune system

If the infection is left untreated, HIV can progress to Acquired Immunodeficiency Syndrome (AIDS), a more advanced stage of infection. In this case, the immune system is severely damaged and the body becomes vulnerable to serious infections, certain cancers, and other chronic illnesses. With proper treatment, most people living with HIV do not develop AIDS and can live long, healthy lives.

HIV is still an important health issue. In 2022, in Canada, about 65,000 people were living with HIV. Anyone can get HIV, but some people and communities are affected more than others because of differences in social conditions, access to care, and biology. For example, about 3 in 4 people living with HIV are men.

What are the symptoms?

Some people develop symptoms 2 to 6 weeks after exposure, while others may have no symptoms for years.

Table 1. Possible symptoms associated with HIV

Early symptoms	Later symptoms (mainly if left untreated)
Fever	Ongoing fever
Swollen lymph nodes	Swollen lymph nodes
Fatigue	Weight loss
Upset stomach or digestive symptoms	Diarrhea
Rash	Skin or scalp irritation
Headache or sore throat	Serious infections such as pneumonia

When symptoms occur, they may last from a few days to several weeks. Even if they disappear, the virus remains in the body, which is why ongoing treatment is important to protect your health and reduce the risk of transmission.

HIV is most commonly transmitted through:

Anal or vaginal sex

Sharing needles or other injection equipment

Mother-to-child transmission (called vertical transmission)

Transmission occurs when infected body fluids enter the body through a mucous membrane (such as the rectum, vagina, penis, or mouth), through a cut, or directly into the bloodstream. HIV can also be passed from a parent living with HIV to their baby during pregnancy, childbirth, or lactation. This is known as vertical transmission.

HIV does not survive long outside the body. Effective treatment greatly reduces the risk of transmission, including during pregnancy, childbirth, and breastfeeding.

What is different about HIV care during pregnancy?

Managing HIV during pregnancy requires specialized follow-up care to reduce risks for both you and your baby.

Monitoring: Viral load is usually checked every 4 to 8 weeks to ensure the virus remains well controlled.
Antiretroviral therapy (ART): Recommended for all pregnant people living with HIV, this treatment helps protect your health and greatly reduces the risk of transmitting HIV to the baby.
Baby’s care: Preventive treatment begins within hours after birth. Babies are also tested regularly for HIV until approximately 18 months of age.

If you are living with HIV and are pregnant or planning a pregnancy, working closely with your healthcare team can help protect both your health and your baby’s health. With effective treatment, the risk of HIV transmission during pregnancy, childbirth, and breastfeeding can be reduced to nearly zero.

2. Why is it important to manage HIV during pregnancy?

During pregnancy, your body goes through many changes, including adaptations of the immune system. If HIV is not treated, it can weaken your immune system and increase the risk of complications for both you and your baby. Early treatment, regular follow-up, and individualized care can greatly improve outcomes during pregnancy.

One of the main concerns during pregnancy when someone has HIV, is the possibility of passing the virus to the baby during pregnancy, birth, or after delivery. When ART are taken properly, the chances of passing HIV to the baby can be reduced from about 15–45% without treatment to less than 1% when treatment is taken consistently.

Understanding Pregnancy Risks

Research helps us estimate the risks linked to common pregnancy-related conditions. Miscarriages (loss of the baby), congenital malformations (birth defect, malformation present at birth), premature birth (before 37 weeks), and other complications can happen in any pregnancy for many reasons. This is the background risk. Research helps estimate how HIV may affect these risks compared to the background risks. It is important to remember:

Some risks are well studied, while others still need more research.
Your personal risk depends on many factors, including access to care, viral load, adherence to treatment, nutrition, and other medical or social conditions.

According to research, when HIV is not managed, it can increase the chances of :

premature birth
having a baby with a low birth weight
loss of the baby before birth.

The table below provides a summary of the potential impacts of untreated or poorly controlled HIV during pregnancy compared to background risks.

Table 2. Possible risks of unmanaged HIV during pregnancy.

Who?	What?	What does research say?
Pregnant person	Fertility	There is not enough research to know if HIV affects fertility tooltip.
	Miscarriage	Some studies show a higher risk, especially older or smaller studies, but others, more recent, found no increased risk tooltip. More research is needed.
	Cesarean delivery	Delivery plans may change based on viral load to lower the chance of passing HIV to the baby. With untreated or poorly controlled HIV, cesarean delivery is the recommended option as it caries lower risk of transmission than vaginal delivery tooltip.
Unborn baby	Congenital malformations	Untreated HIV is not clearly linked to a higher rate of birth defects in the better-quality studies available.
	Babies are more likely to be born early (before 37 weeks) compared to those born to people without HIV tooltip.	Slightly increased risk of preterm birth (before 37 weeks).
	Low birth weight	Babies born to people with HIV are more likely to have low birth weight (less than 5 pounds and 8 ounces [2 500 grammes]) tooltip.
	Passing HIV to the baby (vertical transmission)	If HIV is not treated, there is a high chance it can be passed to the baby.
	Stillbirth	While still rare, there’s a higher risk of stillbirth compared to pregnancies without HIV tooltip.
Future child	Brain development	Some studies show small delays in language and slightly lower memory or processing scores, especially in boys. Social and economic factors also play a big role. (Wedderburn et al.). More research is needed to understand if there’s an impact
Future child	Long-term health issues	Studies found higher chances of hospital stays in children exposed to HIV but not infected. Risk was higher if the baby was very small at birth or if the parent had a detectable viral load at delivery. (Li et al., Brochon et al.)
Family	Father’s role	If the father has HIV and is not treated, the main risk is that HIV could be passed to the mother during conception or pregnancy, and then to the baby.

*These findings describe patterns seen in research studies of many pregnancies. They do not predict what will happen in any one pregnancy.

3. What can I do to manage HIV other than medications?

There is currently no proven therapy that can eliminate HIV without medication. Antiretroviral therapy (ART) remains the most effective way to control the virus and reduce transmission.

However, some strategies can support your overall health and well-being:

Eat a balanced diet: A diet rich in protein, iron, and and essential vitamins (A, B-complex, C, D, zinc)
Stay physically active: Moderate activity can improve energy, mood, and cardiovascular health
Keep routine vaccines up to date: Your healthcare provider can guide you
Attend regular appointments: Monitoring helps ensure treatment remains effective.
Seek support if needed: Emotional, social, and practical support can make a meaningful difference

While these strategies are helpful, they do not replace ART

4. Medications prescribed to manage HIV

Medication is the main and most effective way to treat HIV during pregnancy. Starting and continuing antiretroviral treatment helps protect your health and greatly reduces the chance of passing HIV to your baby.

Antiretroviral therapy (ART) is the standard treatment for HIV. It works by lowering the amount of virus in your body (viral load), often to very low or undetectable levels. This helps keep your immune system strong and can reduce the risk of transmission to your baby to less than 1% when taken consistently.

For this reason, ART is recommended for all pregnant people living with HIV, regardless of viral load or CD4 count. Treatment is personalized to support your routine, reduce side effects, and make it easier to take your medication every day.

Tip: If you have severe nausea during pregnancy, it’s important to tell your healthcare provider as this can affect how well the ART works.

HIV treatment during pregnancy typically involves a combination of medications. Most people will take:

Two medications from one class (called NRTIs), plus
A third medication from a different class

International and National guidelines recommend a combination of combination in pregnancy includes dolutegravir with tenofovir disoproxil fumarate and either emtricitabine or lamivudine. This combination has been widely studied in pregnancy, is effective, generally well tolerated, and works quickly to lower viral load.

Other combinations may also be appropriate. Your care team will help choose the best option based on your individual needs.

What does research say?

Research on ART is ongoing, especially with the development of new medications. So far, the combination ART is considered effective during pregnancy and the best option to prevent complications and health issues for the pregnant person and the baby. Certain medications are preferred because they have the most evidence supporting their use.

Protease inhibitor medications such as Atazanavir/ritonavir (ATV/r) (e.g., Reyataz® + Norvir®) and Lopinavir/ritonavir (LPV/r) (e.g., Kaletra®) are generally avoided during pregnancy, although they may sometimes be continued depending on individual circumstances.

In addition, newer treatment options such as Lenacapavir (e.g., Sunlenca®) are continuing to be developed, expanding the range of available HIV treatment options.

For more detailed information about specific medications, including benefits and possible risks, refer to the individual medication fact sheets.

Table 3. Some medications prescribed in Canada for HIV

Medication Types	Medication Names	Brand names	Comments
Nucleoside/Nucleotide Reverse Transcriptase Inhibitor (NRTI)	Abacavir	e.g. Jamp-Abacavir/Lamivudine ®, Teva-Abacavir/Lamivudine ®, Apo- Abacavir/Lamivudine ®, Triumeq®	Among preferred options
	Emtricitabine	e.g. Truvada®, Emtriva®	Among preferred option
	Lamivudine	e.g. Epivir®, Jamp-Abacavir/Lamivudine, Triumeq®, Dovato®	Among preferred option
	Tenofovir disoproxil fumarate (TDF)	e.g. Viread®, Stribil®	Among preferred option
	Zidovudine	e.g. Retrovir®	Among preferred option
	Tenofovir alafenamide	e.g. Vemlidy®, Biktarvy®	Limited data in pregnancy
Integrase Strand Transfer Inhibitor (INSTI)	Dolutegravir	e.g. Tivicay®, Triumeq®, Dovato®	Among preferred option
	Raltegravir	e.g. Isentress®	Among preferred option, twice daily
	Elvitegravir	e.g. Stribild®	Limited data in pregnancy
	Bictegravir	e.g. Biktarvy®	Among preferred option
	Cabotegravir	e.g. Apretude®, Cabenuva®	Limited data in pregnancy
Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI)	Nevirapine	e.g., JAMP-Nevirapine®	Generally avoided as first-line but continued in some cases
	Efavirenz	e.g., Atripla®	Generally avoided as first-line but continued in some cases
	Rilpivirine	e.g. Edurant®, Cabenuva®	Generally avoided as first-line but continued in some cases
	Doravirine	e.g. Pifeltro®	Limited data in pregnancy
	Etravirine	e.g. Intelence®	Limited data in pregnancy

* Many brand-name medications contain a combination of different HIV treatments. You can see which combination is included by checking the list of active ingredients. ** Not all of these medications are recommended during pregnancy. Always consult a healthcare professional before using any medication during pregnancy.

How do I know which one to take?

Each medication has its benefits and potential risks, which is why it’s important to work with your healthcare team, including your pharmacist, nurse, doctor, or midwife, to make the best decision for you and your baby.

Your healthcare team will consider:

Your viral load and immune health
How far along you are in your pregnancy
Other health conditions (such as hepatitis B)
Possible side effects
What will help you take your medication consistently

If you are already taking HIV medication and become pregnant, do not stop or change your treatment on your own. Always speak with your healthcare provider first.

Taking your medication exactly as prescribed is one of the most important things you can do for your health and your baby’s health. If you have concerns about your medication, side effects, or your treatment plan, talk to your care team—they can help find solutions that work for you.

5. Can HIV or its treatment affect breastfeeding or milk supply (lactation)?

Decisions about infant feeding can be very personal and emotionally significant. If you are living with HIV, it is important to discuss infant feeding with your healthcare professional. If HIV is not treated, it can be transmitted to the baby through human milk. However, if breastfeeding or expressing your milk is important to you, staying on antiretroviral therapy (ART) can help reduce the risk of HIV transmission to the baby (to less than 1%), although the risk is not zero. Some medications are compatible with breast/chest feeding.

Decisions should be made with personalized, evidence-based guidance that takes into account your individual situation, preferences, and access to other feeding options.

If breast/chest feeding is chosen:

preventive treatment for the baby begins shortly after birth
close follow-up with your healthcare team is important to help reduce risks

If you have questions or concerns, your healthcare team (midwife, nurse, physician, pharmacist, or lactation consultant) can help you choose the option that is best for you, whether that is feeding your baby with human milk or infant formula. Resources and support for infant feeding are also available in your province or territory. Together, these professionals can help you explore your options without judgment and support you in feeding your baby.

Key Takeaways

HIV is a virus that attacks the immune system, especially CD4 cells, and can become serious and turn into SIDA if left untreated.
If left untreated, HIV can be transmitted to the baby through pregnancy, childbirth or lactation. There are also higher risks of prematurity, low birth weight, and stillbirth.
ART medication is strongly recommended during pregnancy; it reduces transmission risk to less than 1%.
Breast/chest feeding may be possible in some situations, but it requires individualized counseling because the risk of transmission is low, but not zero.
If you are pregnant and living with HIV, working closely with your healthcare team is one of the best ways to protect your health and your baby’s health.
Always talk with healthcare professionals before starting, changing, or stopping medications.

Research Is Great, But It Is Not Perfect

Making informed health decisions also means understanding what research knows and what it cannot say. Here’s what our experts have found about the research on HIV during pregnancy:

Few pregnancy-specific clinical trials: Most studies were done in non-pregnant adults or through observational pregnancy cohorts.
Confounding factors: Social determinants of health, access to care, stigma, and other medical conditions can influence outcomes.
Limited long-term follow-up: More research is needed on long-term health and development in children who were HIV-exposed but uninfected.
Rare outcomes are difficult to study: Small sample sizes can make it harder to assess rare complications accurately.

These factors can affect the accuracy and reliability of current research, which is why it’s important to consult your healthcare team for personalized advice.

A big thank you to Ashlene Metley, Sameer Kassim, Caley Shukalek, and Sean Sinden for their expertise on the revision of this factsheet.

Other resources

References

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