Epidemiology

Over 40 years into the human immunodeficiency virus (HIV) epidemic, acquired immunodeficiency syndrome (AIDS) is a leading cause of death, globally, in women of reproductive age (15-49 years), particularly in sub-Saharan Africa.​[2]​ HIV/AIDS is also a leading cause of death during pregnancy and after delivery in countries with generalised HIV epidemics and high prevalence. Approximately 12% of all pregnancy-related deaths are attributable to HIV in countries where >2% of the pregnant/postnatal population are living with HIV​.[3]

Globally, there were approximately 39.9 million (range 36.1 to 44.6 million) people living with HIV in 2023, and 53% of all people with HIV were women and girls. Women and girls accounted for 44% of all new infections in 2023 (62% in sub-Saharan Africa). AIDS-related mortality has declined by 56% among women and girls since 2010.[2] In the US, there were 6999 new HIV diagnoses among women in 2019, representing 19% of all new infections. Women aged 24-34 years had the highest number of new diagnoses, and black/African-American women continue to be disproportionately affected. The number of infections in women has remained stable between 2014 and 2019.[4]

Approximately 1.2 million (range 950,000 to 1.4 million) women with HIV worldwide were pregnant in 2023, of whom an estimated 84% received antiretroviral therapy (ART).[5] Untreated, the risk of perinatal transmission of HIV is between 15% and 45%, but can be lowered to 1% or less with a combination of preventative measures including ART for mothers and prophylaxis for neonates.[6][7]​​​ Increased utilisation of ART during pregnancy has led to a dramatic decrease in perinatal transmission and improved maternal outcomes. Internationally, the World Health Organization is working to lower global rates of perinatal transmission to less than 2% (non-breastfeeding populations) or 5% (breastfeeding populations) with the eventual goal of eradicating perinatal transmission of HIV.[8]

Approximately 120,000 new HIV infections occurred in children under 5 years of age globally in 2023, a 62% decline from 2010.[9]

Despite improved health status with the widespread use of ART, women with HIV have persistently higher rates of obstetric and postnatal morbidity, including elevated rates of caesarean delivery, preterm premature rupture of membranes, spontaneous preterm delivery, endometritis, and intensive care unit admission.[10][11][12][13]​​ Post-caesarean complications have decreased dramatically in the US from 210.6/1000 from 1995 to 1996 to 116.6/1000 in 2010 to 2011; however, rates of infection, surgical trauma, hospital deaths, and prolonged hospitalisation remain significantly higher than in women without HIV.[14] Multiple studies suggest that neonates born to women with HIV are at increased risk for complications such as prematurity and being small for gestational age, among others.[7][11]

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