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- Infections Among Newborns
- Testing a Newborn
- Testing Pregnant Women
HCET Home > On-line Training > HIV Risk Assessment in Women > 2. Perinatal Transmission of HIV
2. Perinatal Transmission of HIVHIV infections among newborns declined 80% from 1991 to 2000
| “This dramatic reduction in the number of infections in newborns clearly demonstrates remarkable progress. However, we must continue our efforts to extend these successes in the U.S.” - Harold Jaffe, M.D., Acting Director of CDC HIV/STD, and TB Prevention Programs |
- The risk for perinatal HIV transmission is significantly increased if the mother has more advanced disease or if there is premature rupture of membranes.
- The mode of delivery may impact HIV transmission. Each client should be informed of all risks and benefits in order to reach an informed decision.
- Breastfeeding may also serve as a route of transmission and is not recommended for women who have access to safe alternatives.
Infection with HIV is does not occur with every HIV infected woman. An estimated 25% of babies born to untreated mothers infected with HIV will be infected. However, early diagnosis and antiretroviral therapy can reduce transmission rate to 3-4% (13).
- Findings from the AIDS Clinical Trial Group (ACTG) 076 study indicate that the transmission rate can be reduced to 8% when AZT is given to an HIV-infected mother during pregnancy, during labor and to the neonate after delivery.
- Current treatment regimens include a combination of anti-HIV drugs that may decrease the risk of transmission to as low as 1.1%. (14)
HIV Testing for a Newborn
HIV exposed infants will test positive for HIV IgG antibodies until about 18 months of age because of maternal transplacental passage and for many years, infection could not be ruled out until 18 months of age. HIV testing has advanced and now HIV infection in the newborn can be determined in almost all exposed children by the age of 6 months.
The standard for diagnosis of HIV infection in exposed infants is the use of viral assays obtained: [HIV DNA PCR (preferred), HIV RNA, or viral culture] within 48 hours of birth, at 1-2 months of age, and at 3-6 months of age. HIV can be excluded with 2 or more negative tests, one which is performed at age >1 month and one performed at 4 months of age.
If antiretrovirals are used during pregnancy or at the time of delivery, the child should be followed to assess any long-term effects (14).
For more information
- CDC Press Release HIV Infections in U.S. Newborns Decline 80 Percent Since 1991
HIV Testing of Pregnant Women
CDC promotes recommendations that for routine HIV testing of all pregnant women regardless of known risk (MMWR, April 18,2003/52(15);329-332).
Early diagnosis of HIV infection allows women to make informed decisions the use of about antiretrovirals during pregnancy and treatment of the newborn if needed (14).
Preventing HIV infection in the newborn is highly possible if the provider is aware of infection in the mother. Many people in this country are unaware that they are infected with HIV and many who do test positive report low or no risk for infection, especially women. One study showed that if only women with known risk were tested, only 57% of infected women would have been identified (7).
Activity: The following identifies risk factors for mothers of pediatric AIDS cases. Note the large percentage of women whose risk is unspecified. The majority of these cases could be attributed to heterosexual transmission, some to injecting drugs. Some could not identify a risk.
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Figure 9:
For more information
- Revised Guidelines for HIV Counseling, Testing, and Referral
and Revised Recommendations for HIV Screening of Pregnant Women in PDF
format
- Chapter VII: HIV AND REPRODUCTION by Jean R. Anderson, MD
