1. During pregnancy, through the placenta.
2. At the time of delivery, through exposure to the mother's bodily fluid.
3. While breast feeding.

Tests for Mother's-to-be

The two tests that can help decide whether you would require an HIV treatment are:

• The CD4 test will tell you how strong your immune system. Higher your CD4 count, stronger the immune system.
• The Viral Load test determines the amount of HIV in your blood. Higher your viral load (40,000 copies and above), greater your chances of having an HIV positive baby.

Treatment During Pregnancy

The cheapest and most popular therapy in India is the Anti-Retro-Viral (ARV) three drug therapy. It is a combination therapy containing ARV's Zidovudine (ZDV) + Lamivudine (3TC) + Nevirapine.

These drugs help reduce the risk of passing HIV from a mother to her baby. It also prevents infected persons from falling ill.

For mothers with a low viral load, the drug is given only during the last trimester. If it is high, then the therapy is recommended right after the first trimester. The first trimester is when the organs of the baby begin to develop, so the drugs may affect foetal development.

In case you are unaware that you are pregnant and have been taking ARVs, you may be advised to terminate the pregnancy.

Follow-ups to Reduce Risk

Opt for a c-section as it reduces the chance of the baby's blood mixing with yours.

A vaginal delivery is possible if the CD4 count is high and the virus level is low.

Within 48 hours of delivery, both mother and baby should be given an ARV drug called Nevirapine. This will minimise any risk or complication.

Then feed your baby protein-rich formula milk. Avoid breast milk completely, as it can also pass the virus.

Testing Your Baby

HIV takes at least 18 months to show up in blood tests.

A PCR (Polymerase Chain Reaction) and an HIV antibody test are conducted after 18 months to determine whether a child is infected. Even then it needn't be visible.

It will take atleast two to three years to determine for sure whether a baby is infected.

Meanwhile, continue taking the ARV therapy as prescribed by your doctor.

(With inputs from Dr. Alka Deshpande, AIDS Specialist, J.J. Hospital, Mumbai)