HIV Among Pregnant Women, Infants and Children in the United States
Perinatal HIV transmission, also known as mother-to-child transmission, can happen at any time during pregnancy, labor, delivery, and breastfeeding. CDC recommends that all women who are pregnant or planning to get pregnant take an HIV test as early as possible before and during every pregnancy. This is because the earlier HIV is diagnosed and treated, the more effective HIV medicine, called antiretroviral treatment (ART), will be at preventing transmission and improving the health outcomes of both mother and child.
Advances in HIV research, prevention, and treatment have made it possible for many women living with HIV to give birth without transmitting the virus to their babies. The annual number of HIV infections through perinatal transmission have declined by more than 90% since the early 1990s. Today, if a woman takes HIV medicine daily as prescribed throughout pregnancy, labor, and delivery and gives HIV medicine to her baby for 4-6 weeks after delivery, the risk of transmitting HIV to the baby can be as low as 1% or less. When the HIV viral load is not adequately reduced, a Cesarean delivery can also help to prevent HIV transmission. After delivery, a mother can prevent transmitting HIV to her baby by not breastfeedinga and not pre-chewing her baby's food.
For babies living with HIV, starting treatment early is important because the disease can progress more quickly in children than adults. Providing ART early can help children with perinatal HIV live longer, healthier lives.
It is important that all women who are pregnant or trying to get pregnant encourage their partners to also get tested for HIV. Women who are HIV-negative but have an HIV-positive partner should talk to their doctor about taking HIV medicine daily, called pre-exposure prophylaxis (PrEP), to protect themselves while trying to get pregnant, and to protect themselves and their baby during pregnancy and while breastfeeding.
HIV Diagnoses and Prevented Cases of Perinatal HIV Transmission
- Approximately 8,500 women living with HIV give birth annually (based on an estimate from 2006, the most recent available).
- Between 1994 and 2010, an estimated 21,956 cases of perinatally acquired HIV infections were prevented.
- In 2016, 99 children under the age of 13 received a diagnosis of perinatally acquired HIV.
Living With HIV
- At the end of 2015, 1,872 children2 were living with diagnosed perinatal HIV. Of these 1,206 (64%) were black/African American, 279 (15%) were Hispanic/Latino,3 and 198 (11%) were white.
- At the end of 2015, 9,728 adults and adolescents (aged 13 and older) were living with diagnosed HIV acquired through perinatal transmission. Of these, 58% (5,679) were black/African American, 24% (2,380) were Hispanic/Latino, and 12% (1,125) were white.
- From the beginning of the epidemic through 2014, there were 5,419 deaths among people who acquired HIV through perinatal transmission and were ever diagnosed with AIDS.3 Most of the deaths (82%) were among children (under age 13).
- Pregnant women with HIV may not know they are infected. CDC recommends HIV testing for all women as part of routine prenatal care. According to CDC research, more women take the prenatal HIV test if the opt-out approach is used. Opt-out prenatal HIV testing means that a pregnant woman is told she will be given an HIV test as part of routine prenatal care unless she opts out -- that is, chooses not to have the test. In some parts of the country where HIV among women is more common, CDC recommends a second test during the third trimester of pregnancy. In 2016, the American Medical Association created a new Common Procedural Terminology (CPT) code that includes HIV testing in the Obstetric Panel. This allows prenatal care providers to order just one panel that includes many standard serologic tests for pregnant women, including HIV.
- Women living with HIV may not know they are pregnant, how to prevent or safely plan a pregnancy, or what they can do to reduce the risk of transmitting HIV to their baby. For women living with HIV, it is important that they
- Visit their health care provider regularly.
- Take HIV medicine as directed for their own health and if they want to get pregnant.
- Take HIV medicine throughout the pregnancy, labor, and delivery, as prescribed.
- Ensure their infant gets HIV medicine after delivery.
- Avoid breastfeeding.
- Avoid pre-chewing food for an infant, toddler, or anyone else.
- To get the full protective benefit of HIV medicine, the mother needs to take it as prescribed -- without interruption -- throughout pregnancy, labor, and delivery, and provide HIV medicine to her infant. Pregnant women living with HIV may have nausea during pregnancy that can interfere with taking medicines, and new mothers may not be able to see their HIV medical care provider consistently.
- Social and economic factors, especially poverty, affect access to all health care, and disproportionately affect people living with HIV. Pregnant women living with HIV may face more barriers to accessing medical care if they also use injection drugs; use other substances; or are homeless, incarcerated, mentally ill, or uninsured.
What CDC Is Doing
- CDC has developed a framework to guide federal agencies and other organizations in their efforts to reduce the rate of perinatal transmission of HIV to less than 1% among infants born to women with HIV and less than 1 perinatal transmission per 100,000 live births.
- CDC supports CityMatCH to convene a group of stakeholders representing a broad network of public health professionals and clinical care providers to implement the framework. CityMatCH will develop and disseminate strategies for health departments to describe their progress in -- and/or maintenance of -- elimination. They will also develop and disseminate best practice models for the integration of obstetric/gynecologic care, HIV care, and mental health and substance-use treatment services. Further, they will develop educational and best-practice-sharing networks for the perinatal HIV prevention workforce including clinical care providers and public health professionals.
- CDC funds perinatal HIV prevention through the Integrated Human Immunodeficiency Virus Surveillance and Prevention Programs for Health Departments. Key partner activities include promoting HIV testing and ART for pregnant women; an HIV surveillance and birth registry match to identify mother-infant pairs in need of services; perinatal HIV exposure surveillance; and a community-based quality improvement process using case reviews, that is, the FIMR-HIV methodology, and perinatal HIV services coordination.
- Taking HIV medicine as prescribed can make a person's viral load very low -- even so low that a test can't detect it (called an undetectable viral load). We don't know if a woman with an undetectable viral load can transmit HIV to her baby through breastfeeding. Being undetectable very likely reduces the risk, but we don't know by how much. In the United States, where safe alternatives to breastmilk are available, a woman living with HIV should avoid breastfeeding, even when viral load is undetectable.
- 13 years of age and younger.
- Hispanics/Latinos can be of any race.
- Diagnoses of HIV infection in the United States and dependent areas, 2016. HIV Surveillance Report 2017;28.
- Monitoring selected national HIV prevention and care objectives by using HIV surveillance data -- United States and 6 dependent areas -- 2015. HIV Surveillance Supplemental Report 2015;22(2).
- Little KM, Taylor AW, Borkowf CB, et al. Perinatal Antiretroviral Exposure and Prevented Mother-to-child HIV Infections in the Era of Antiretroviral Prophylaxis in the United States, 1994-2010. Pediatr Infect Dis J 2017 Jan; 36(1), 66-71.
- Panel on Treatment of HIV-Infected Pregnant Women and Prevention of Perinatal Transmission. Recommendations for use of antiretroviral drugs in pregnant HIV-1-infected women for maternal health and interventions to reduce perinatal HIV transmission in the United States. AIDSinfo 2016; D1-D10. Accessed January 12, 2017.
- Pediatric HIV surveillance (through 2014). Slide set.
- Townsend CL, Cortina-Borja M, Peckham CS, de Ruiter A, Lyall H, Tookey, PA. Low rates of mother-to-child transmission of HIV following effective pregnancy interventions in the United Kingdom and Ireland, 2000-2006. AIDS 2008;22(8):973-81.
- Achievements in public health: reduction in perinatal transmission of HIV infection -- United States, 1985-2005. MMWR 2006;55(21):592-97.
- Fleming PL, Lindegren ML, Byers R, et al. Estimated number of perinatal HIV infections, U.S., 2000. Poster Exhibition: XIV International AIDS Conference. Barcelona, Italy. 2002 Jul 7-12;14: Abstract No. TuPeC4773.
- Whitmore SK, Zhang X, Taylor AW, Blair JM. Estimated number of infants born to HIV-infected women in the United States and five dependent areas, 2006. J Acquir Immune Defic Syndr 2011;57:218-22.
- Valverde E, Short W, Brady K, Frazier E, Beer L, Mattson C. HIV medical provider's assessment of the reproductive plans of women receiving HIV care: Medical Monitoring Project Provider Survey, 2009. 6th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2011). Rome, Italy. 2011 Jul 17-20; Abstract No. TUPE307.
- Whitmore SW, Taylor AW, Espinoza L, Shouse FL, Lampe MA, Nesheim SR. Correlates of mother-to-child HIV transmission in the United States and Puerto Rico. Pediatrics 2012 Jan;129:e74-81.
- Taylor AW, Nesheim S, Whitmore S, et al. Estimated number and characteristics associated with perinatal HIV infections, 33 states, United States, 2003-2007. 6th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2011). Rome, Italy. 2011 Jul 17-20; Abstract No. TUPDC0103.
- Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR 2006;55(RR-14):1-17.
- Barrow RY, Newman LM, Douglas JM Jr. Taking positive steps to address STD disparities for African American communities. Sex Transm Dis 2008;35(12 Suppl):S1-S3.
- Gaur AH, Dominguez KL, Kalish ML, et al. Practice of feeding premasticated food to infants: a potential risk factor for HIV transmission. Pediatrics 2009;124:658-66.
- Lampe MA, Smith DK, Anderson GJ, Edwards AE, Nesheim SR. Achieving safe conception in HIV-discordant couples: the potential role of oral preexposure prophylaxis (PrEP) in the United States. Am J Obstet Gynecol 2011;204:488.e1-8.
- Luzuriaga K, Tabak B, Garber M, et al. HIV Type 1 (HIV-1) Proviral Reservoirs Decay Continuously Under Sustained Virologic Control in HIV-1-Infected Children Who Received Early Treatment. J Infect Dis 2014 May; 210 (10), 1529-1538.
Mother to Child Transmission Resources (AIDS Education and Training Centers)
Women, Children, and HIV (University of California, San Francisco)
Cervical Cancer and HIV (SmartGlobalHealth.org)
- CDC-INFO 1-800-CDC-INFO (232-4636)
- CDC HIV Website
- CDC Act Against AIDS Campaign
- CDC HIV Risk Reduction Tool (BETA)
[Note from TheBody: This article was created by the U.S. Centers for Disease Control and Prevetion, who last updated it on March 21, 2018. We have cross-posted it with their permission.]