HIV/AIDS in pregnant women and infants

Most children with HIV get the virus when it passes from an HIV-positive mother to the child. This can occur during pregnancy, childbirth, or when breastfeeding.

Only blood, semen, vaginal fluids, and breast milk have been shown to transmit infection to others.

The virus is NOT spread to infants by:

• Casual contact, such as hugging or touching
• Touching items that were touched by a person infected with the virus, such as towels or washcloths
• Saliva, sweat, or tears that is NOT mixed with the blood of an infected person

Most infants born to HIV-positive women in the United States do not become HIV positive if the mother and infant have good prenatal and postpartum care that includes antiretroviral therapy (ART).

Infants who are infected with HIV often have no symptoms for the first 2 to 3 months. Once symptoms develop, they can vary. Early symptoms may include:

• Yeast (candida) infections in the mouth
• Failure to gain weight and grow
• Swollen lymph glands
• Swollen salivary glands
• Enlarged spleen or liver
• Ear and sinus infections
• Upper respiratory tract infections
• Being slow to walk, crawl, or speak compared to healthy babies
• Diarrhea

Early treatment often prevents the HIV infection from progressing.

Without treatment, a child's immune system weakens over time, and infections that are uncommon in healthy children develop. These are severe infections in the body. They can be caused by bacteria, viruses, fungi, protozoa, or parasites. At this point, the illness has become full-blown AIDS.

Here are the tests a pregnant mother and her baby may have to diagnose HIV:

TESTS TO DIAGNOSE HIV IN PREGNANT WOMEN

All pregnant women should have a screening test for HIV along with other prenatal tests. Women at high risk should be screened a second time during the third trimester.

Mothers who have not been tested can receive a rapid HIV test during labor.

Woman known to be HIV positive during pregnancy will have regular blood tests, including:

• CD4 counts
• Viral load test, to check how much HIV is in the blood
• A test to see if the virus will respond to the medicines used to treat HIV (called a resistance test)

TESTS TO DIAGNOSE HIV IN BABIES AND INFANTS

Infants born to women infected with HIV should be tested for HIV infection. This test looks for how much of the HIV virus is in the body. In infants born to HIV positive mothers, HIV testing is done:

• 14 to 21 days after birth
• At 1 to 2 months
• At 4 to 6 months

If the result of 2 tests is negative, the infant does NOT have an HIV infection. If the results of any test are positive, the baby has HIV.

Babies who are at very high risk for HIV infection may be tested at birth.

HIV/AIDS is treated with ART. These medicines stop the virus from multiplying.

TREATING PREGNANT WOMEN

Treating pregnant women with HIV prevents children from becoming infected.

• If a woman tests positive during pregnancy, she will receive ART while pregnant. Most often she will receive a three-drug regimen.
• The risk of these ART medicines for the baby in the womb is low. The mother may have another ultrasound at the second trimester.
• HIV may be found in a woman when she goes into labor, particularly if she has not previously received prenatal care. If so, she will be treated with ART right away. Sometimes these drugs will be given through a vein (IV).
• If the first positive test is during labor, receiving ART right away during labor can reduce the rate of infection in children to about 10%.

TREATING BABIES AND INFANTS

Infants born to infected mothers start receiving ART within 6 to 12 hours after birth. One or more antiretroviral medicines should be continued for at least 6 weeks after birth.

BREASTFEEDING

HIV-positive women should not breastfeed. This holds true even for women who are taking HIV medicines. Doing so may pass HIV to the baby through breast milk.

The challenges of being a caretaker of a child with HIV/AIDS can often be helped by joining a support group. In these groups, members share common experiences and problems.

The risk of a mother transmitting HIV during pregnancy or during labor is low for mothers identified and treated with ART early in pregnancy. When treated, the chance of her baby being infected is less than 1%. Because of early testing and treatment, there are fewer than 200 babies born with HIV in the United States per year.

If a woman's HIV status is not found until the time of labor, ART can reduce the rate of infection in infants to about 10%.

Children with HIV/AIDS will need to take ART for the rest of their life. The treatment does not cure the infection. The medicines only work as long as they are taken every day. With proper treatment, children with HIV/AIDS can live a nearly normal lifespan.

Contact your health care provider if you have HIV or are at risk for HIV, and you become pregnant or are thinking of becoming pregnant.

HIV-positive women who might become pregnant should talk to their provider about the risk to their unborn child. They should also discuss methods to prevent their baby from becoming infected, such as taking ART during pregnancy. The earlier the woman starts ART, the lower the chance of infection in the child.

Women with HIV should not breastfeed their baby. This will help prevent passing HIV to the infant through breast milk.

HIV infection - children; Human immunodeficiency virus - children; Acquired immune deficiency syndrome - children; Pregnancy - HIV; Maternal HIV; Perinatal - HIV

Clinicalinfo.HIV.gov website. Guidelines for the use of antiretroviral agents in pediatric HIV infection. clinicalinfo.hiv.gov/en/guidelines/pediatric-arv/whats-new-guidelines. Updated January 31, 2023. Accessed February 28, 2023.

Clinicalinfo.HIV.gov website. Recommendations for use of antiretroviral drugs in pregnant women with HIV infection and interventions to reduce perinatal HIV transmission in the United States. clinicalinfo.hiv.gov/en/guidelines/perinatal/whats-new-guidelines. Updated January 31, 2023. Accessed February 28, 2023.

Hayes EV. Human immunodeficiency virus and acquired immunodeficiency syndrome. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 302.

Weinberg GA, Siberry GK. Pediatric human immunodeficiency virus infection. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 127.

Updated by: Jatin M. Vyas, MD, PhD, Associate Professor in Medicine, Harvard Medical School; Associate in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. Editorial update 02/28/2023.