Management of Infants Born to Mothers with HIV Infection

 

Am Fam Physician. 2021 Jul ;104(1):58-62.

  Patient information: See related handout on preventing HIV infection in babies, written by the authors of this article.

Author disclosure: No relevant financial affiliations.

In the United States, approximately 5,000 women living with HIV infection give birth each year. HIV can be transmitted from a mother to her child at any time during pregnancy, labor and delivery, and breastfeeding. Because of effective preventive measures, the transmission rate from pregnant women to their children has declined significantly. Strategies to prevent mother-to-child transmission include maternal and infant antiretroviral therapy and formula-feeding instead of breastfeeding. All infants born to mothers with HIV infection should receive antiretroviral postexposure prophylaxis as soon as possible, ideally within six hours after delivery. The type of prophylaxis depends on whether the mother has achieved virologic suppression, defined by an HIV RNA load of less than 50 copies per mL, and if the infant is at high risk of vertical transmission of HIV. Risk factors for vertical transmission include maternal seroconversion during pregnancy or breastfeeding, high maternal plasma viral RNA load during pregnancy, and advanced maternal HIV disease.

In the United States, approximately 5,000 women living with HIV infection give birth each year.1 Since the initial Pediatric AIDS Clinical Trials Group Protocol 076 (PACTG 076) study was published in 1994, advances in the management of HIV infection have led to a dramatic decline in the incidence of perinatally infected infants.2,3 The annual rate of perinatal HIV transmission has decreased by more than 95% in the United States since the early 1990s.2,3 In 2017, only 73 infants were born with HIV infection in the United States. Five states (Florida, Texas, Georgia, Louisiana, and Maryland) accounted for 38% of infants born with HIV infection in the United States in 2016.46

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Antenatal testing and treatment of pregnant women have reduced vertical transmission rates; however, opportunities remain to further decrease vertical transmission, and inadequate antenatal

The Authors

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VINI VIJAYAN, MD, FAAP, FIDSA, is program director of the Valley Children's Healthcare Pediatric Residency Program; an affiliate associate professor of pediatrics at Stanford University School of Medicine; and a pediatric infectious disease specialist at Valley Children's Healthcare, Madera, Calif....

FOUZIA NAEEM, MD, is chair of the Antimicrobial Stewardship Program; an affiliate clinical assistant professor of pediatrics at Stanford (Calif.) University School of Medicine; and a pediatric infectious disease specialist at Valley Children's Healthcare.

ANGELA F. VEESENMEYER, MD, MPH, is a clinical associate professor in the Department of Child Health at the University of Arizona College of Medicine and a pediatric infectious disease specialist at Valleywise Health Medical Center, Phoenix, Az.

Address correspondence to Vini Vijayan, MD, FAAP, FIDSA, Valley Children's Healthcare, 9300 Valley Children's Pl., Madera, CA 93636 (email: vvijayan@valleychildrens.org). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

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