HIV and pregnancy

HIV in pregnancy is the presence of an HIV/AIDS infection in a woman while she is pregnant. There is a risk of HIV transmission from mother to child in three primary situations: pregnancy, childbirth, and while breastfeeding. This topic is important because the risk of viral transmission can be significantly reduced with appropriate medical intervention, and without treatment HIV/AIDS can cause significant illness and death in both the mother and child. This is exemplified by data from The Centers for Disease Control (CDC): In the United States and Puerto Rico between the years of 2014–2017, where prenatal care is generally accessible, there were 10,257 infants in the United States and Puerto Rico who were exposed to a maternal HIV infection in utero who did not become infected and 244 exposed infants who did become infected.^[1]

The burden of the HIV/AIDS pandemic, including mother-to-child transmission of HIV, disproportionately affects low- and middle-income countries, in particular the countries of Southern Africa.^[2] The World Health Organization (WHO) estimates that 1.3 million women and girls living with HIV become pregnant each year.^[3]

The risks of both neonatal HIV infection and maternal illness are reduced by appropriate prenatal screening, treatment of the HIV infection with antiretroviral therapy (ART), and adherence to recommendations after birth. Notably, without antiretroviral medications, obstetrical interventions, and breastfeeding recommendations, there is approximately a 30% risk of mother-to-child HIV transmission.^[4] This risk is reduced to less than 1% when the previously mentioned interventions are employed.^[5] The American College of Obstetrics and Gynecology (ACOG) therefore recommends HIV testing as a routine component of both pre-pregnancy and first trimester prenatal care to ensure expedient and appropriate interventions.^[6]

HIV infection is not a contraindication to pregnancy. Women with HIV may choose to become pregnant if they so desire, however, they are encouraged to talk with their doctors beforehand. Notably, 20-34% of women in the United States living with HIV are unaware of their diagnosis until they become pregnant and undergo prenatal screening.^[7]