Pregnancy, Pediatrics and HIV Infection:  Guidelines for Your Practice

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Maternal-Infant Transmission of HIV

 
Maternal-infant transmission is the primary means of infecting children with human immunodeficiency virus type 1 (HIV); however, perinatal HIV transmission during pregnancy is no longer inevitable. The use of medical and obstetrical interventions has led to a dramatic decrease in perinatal HIV-1 transmission.  Some of these interventions including preconceptual counseling of HIV disease, knowing the serostatus of a woman as early in pregnancy as possible, using antiretroviral drugs to prevent perinatal HIV transmission, choosing elective Cesarean section for a woman with a viral load greater than 1000 copies/ml and avoiding breast feeding by infected women can further reduce the risk of perinatal HIV transmission.   Novel approaches to decrease perinatal HIV transmission further and to improve maternal health are currently under investigation.

Steps to Lowering the Risk of Perinatal HIV Transmission

  • Provide preconceptual counseling.

  • Determine the serostatus of a pregnant woman as soon as possible.

  • Use antiretroviral agents to prevent perinatal transmission.

  • Recommend Cesarean section for women with viral loads >= 1000.

  • Caution infected women against breast-feeding.

  • Initiate intrapartum and neonatal antiretroviral therapy for HIV infected women with no prenatal care.
However, perinatal transmission of HIV can be influenced by several other factors:
Obstetric Factors
  • Increased duration of ruptured membranes
  • Route of delivery
  • Use of invasive procedures
  • Clinical or subclinical chorioamnionitis
Maternal Factors
  • High viral load
  • Low CD4 lymphocyte count
  • Co-infection with hepatitis C, cytomegalovirus, bacterial vaginosis, herpes
  • Injection drug use
  • Not using antiretroviral agents during pregnancy
  • Maternal weight
Infant Factor
  • Prematurity
 

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