Having HIV does not stop you having a healthy baby. When the parent takes HIV medicine through pregnancy and birth, and the baby takes HIV medicine after birth, the risk of passing HIV to the baby can be 1% or less9.
This guide walks through the main steps: your treatment in pregnancy, giving birth, your baby’s medicine and feeding. Every pregnancy is different, and your HIV and maternity teams will plan the details with you.
HIV testing in pregnancy
US guidelines recommend an HIV test as early as possible in every pregnancy, offered routinely to everyone, and testing for partners whose status is unknown. Some people are tested again later in pregnancy, for example if their risk of HIV is higher7. Finding HIV early gives the most time to get the virus under control before the birth.
If you are already taking HIV medicine
- Keep taking it. If your treatment suits you and keeps your viral load undetectable, the usual advice is to carry on with it1.
- Do not stop. The US guidelines strongly recommend against stopping HIV treatment during pregnancy1.
- Tell your HIV team as soon as you know you are pregnant. The body changes in pregnancy can change medicine levels, especially later on, so your team will check your regimen early1. Do not switch or stop medicines on your own.
If you are not on treatment yet
Start as early in pregnancy as possible, whatever your viral load or CD4 count1. The UK guideline also recommends starting as soon as possible, ideally in the first three months, especially if the viral load is high or the CD4 count is low8. The aim is to make the virus undetectable before the birth1. For what viral load and CD4 numbers mean, see our guide to viral load and CD4 count.
Which HIV medicines are used in pregnancy?
The choice is made together with your healthcare provider, weighing what is known about each medicine in pregnancy1. The US guidelines list these as preferred options for people starting treatment in pregnancy2:
| Preferred option | Why it is used |
|---|---|
| Biktarvy (bictegravir, emtricitabine, tenofovir alafenamide) | One tablet once a day, no food rules, no dose change needed in pregnancy. Levels fall later in pregnancy but stayed high enough in studies2. |
| Dolutegravir plus two other medicines (tenofovir with emtricitabine or lamivudine) | Once a day, no dose change needed, and it lowers the viral load quickly, which helps when treatment starts late in pregnancy2. |
Dolutegravir and birth defects. You may have read about an early worry that dolutegravir taken around conception could cause neural tube defects (problems with the developing spine and brain). The US guidelines now say that taking dolutegravir in the first three months of pregnancy has not been linked to a higher risk of birth defects, including neural tube defects3.
Pregnancy vitamins. If you take dolutegravir, there are timing rules for taking it with supplements that contain iron or calcium, such as many pregnancy vitamins2. Ask your pharmacist how to space them. Our guide to HIV medicine interactions explains why.
For more on these two medicines, see our comparison of Dovato, Biktarvy and Triumeq.
Giving birth
Keep taking your HIV medicine on schedule during labour and before a planned caesarean4. How the birth is planned depends mostly on your viral load near the end of pregnancy.
| Viral load near the birth | US guidelines | UK guidelines |
|---|---|---|
| Undetectable (below 50) | A caesarean just because of HIV is not recommended; no extra drip needed4 | A planned vaginal birth is supported8 |
| Low but detectable | Up to 1,000: a caesarean just because of HIV is not recommended; a zidovudine drip may be considered4 | 50 to 399: a planned caesarean is recommended, taking your situation into account8 |
| Higher, or unknown | Above 1,000 or unknown: planned caesarean at 38 weeks, and zidovudine through a drip before and during the birth4 | 400 or more: a caesarean is recommended8 |
Viral loads are measured in copies per millilitre of blood. Your team will plan the birth with you well before your due date.
Your baby’s HIV medicine
Every baby born to a parent with HIV is given HIV medicine from birth, ideally within 6 hours5. How much depends on the parent’s viral load in pregnancy5:
- Lower risk (viral load below 50 from 20 weeks of pregnancy until the birth): one medicine, zidovudine, for 2 weeks5.
- Higher risk (viral load of 50 or more in the 4 weeks before the birth): a three-medicine treatment for 2 to 6 weeks, making 6 weeks of medicine in total5.
Your baby will also have HIV tests in the first months to confirm they do not have HIV5.
Feeding your baby
This is where “undetectable equals untransmittable” (U=U) does not fully apply. Treatment greatly reduces the risk of passing HIV through breast milk, but it does not remove it8.
- Formula or donated milk from a milk bank removes the risk of passing HIV after birth completely68.
- US guidelines: staying undetectable lowers the risk through breastfeeding to less than 1%, but not zero. If your viral load has been below 50 for at least 3 months before the birth, you should be offered the choice and supported in whichever you choose. Breastfed babies usually need more tests and sometimes extra medicine6.
- UK guidelines: formula is recommended so the risk is zero, but people with a viral load below 50 who take their treatment well and choose to breastfeed should be supported. Parent and baby have monthly viral load tests while breastfeeding and for 2 months after stopping8.
- If your viral load becomes detectable while breastfeeding, US guidelines advise pausing or stopping breastfeeding and switching to formula while it is checked6.
Guidance differs between countries, so start the conversation early. The UK guideline suggests discussing feeding plans by the end of the middle three months of pregnancy at the latest8.
After the birth
Keep taking your HIV medicine. The UK guideline recommends lifelong treatment for the parent8. The weeks after a birth are busy and tiring, which is when doses get missed. Our guide to missed HIV medication doses can help.
If you are the partner without HIV, or you are planning a pregnancy as a mixed-status couple, see our guides to U=U and PrEP for couples and PrEP for women.
Medicines discussed here that we supply include dolutegravir (Doluvir 50 mg) and tenofovir with emtricitabine (Truvada, Tenvir-EM). Treatment in pregnancy must be planned with your HIV team, and all need a prescription.
Frequently asked questions
Can a woman with HIV have a healthy baby?
Yes. With HIV medicine through pregnancy and birth, and medicine for the baby afterwards, the chance of the baby getting HIV can be 1% or less.
Can I pass HIV to my baby if I am undetectable?
The risk during pregnancy and birth is very low when you are undetectable and your baby takes HIV medicine after birth. Breastfeeding still carries a small risk, so talk through feeding options with your team.
Is dolutegravir safe in pregnancy?
The US guidelines list dolutegravir as a preferred medicine in pregnancy. They say taking it in the first three months has not been linked to a higher risk of birth defects, including neural tube defects.
Is Biktarvy safe in pregnancy?
The US guidelines list Biktarvy as a preferred option for people starting treatment in pregnancy. Its levels fall later in pregnancy but stayed high enough in studies, and no dose change is needed.
Will I need a caesarean?
Not if your viral load is undetectable near the birth, unless there is another reason. A planned caesarean is recommended when the viral load is higher; the exact cut-off differs between US and UK guidelines.
Can I breastfeed if I have HIV?
Formula removes the risk completely. US and UK guidelines both support people who choose to breastfeed if their viral load is undetectable and they take treatment well, with extra tests for parent and baby. Plan this with your HIV team during pregnancy.
How long does my baby take HIV medicine?
In the US, 2 weeks of zidovudine if your viral load was below 50 from 20 weeks of pregnancy, and up to 6 weeks if there was a higher risk. Your baby’s doctors will confirm the plan.
Sources & references
- NIH Panel on Treatment of HIV During Pregnancy and Prevention of Perinatal Transmission. Recommendations for Use of Antiretroviral Drugs During Pregnancy: Overview. Updated 31 March 2026.
- NIH Perinatal Guidelines. Table 6. What to Start: Initial Antiretroviral Regimens During Pregnancy. Updated 31 March 2026.
- NIH Perinatal Guidelines. Appendix B: Dolutegravir, Safety and Toxicity in Pregnancy. Updated 31 March 2026.
- NIH Perinatal Guidelines. Intrapartum Care for People With HIV. Updated 12 June 2025.
- NIH Perinatal Guidelines. Antiretroviral Management of Infants With In Utero, Intrapartum, or Breastfeeding Exposure to HIV. Updated 25 June 2026.
- NIH Perinatal Guidelines. Preventing HIV Transmission During Infant Feeding. Updated 25 June 2026.
- NIH Perinatal Guidelines. Pregnancy and Postpartum HIV Testing and Identification of Perinatal and Postnatal HIV Exposure. Updated 19 May 2025.
- British HIV Association. BHIVA guidelines on the management of HIV in pregnancy and the postpartum period 2025.
- HIV.gov. HIV Treatment as Prevention. Updated 28 August 2026.
Related reading
This content is for informational purposes only and is not medical advice. HIV care in pregnancy must be planned with your HIV, maternity and baby’s care teams; never stop or change HIV medicine during pregnancy without them. Used as prescribed by a licensed medical professional.
A. Srinivasan is a licensed clinical pharmacist with 24 years of experience. He holds a B.Pharm and M.Pharm from University of Madras. At OnlineMeds, he reviews medicine and health content to help ensure it is accurate, evidence-based, and easy to understand.