HIV infection in pregnancy

Human immunodeficiency virus (HIV) infection in pregnancy not only poses a threat to maternal immune health, but can lead to transmission of HIV in utero, intrapartum, or through breast-feeding postpartum.

All pregnant women should be tested for HIV as early as possible in pregnancy. Repeat testing is recommended in the third trimester for pregnant women with initial negative tests who have high potential HIV exposure, live in an area with a high HIV prevalence, or receive care at a facility with a high HIV incidence.

HIV-exposed infants should be tested for HIV infection at birth and seek specialty care for follow-up testing and treatment.

All pregnant women with HIV should receive antiretroviral therapy (ART), as early as possible in the pregnancy, regardless of CD4 count or viral load. ART should be prescribed continuously during the antepartum, intrapartum, and postpartum periods, as well as prophylaxis for the neonate.

Evidence-based, patient-centered counseling regarding breast-feeding and replacement feeding is recommended to inform shared decision-making.

HIV is a retrovirus that causes HIV infection by infecting CD4 T cells and can lead to acquired immunodeficiency syndrome.[1]Van de Perre P, Simonon A, Msellati P, et al. Postnatal transmission of human immunodeficiency virus type 1 from mother to infant. A prospective cohort study in Kigali, Rwanda. N Engl J Med. 1991 Aug 29;325(9):593-8. http://www.ncbi.nlm.nih.gov/pubmed/1812850?tool=bestpractice.com Pregnancy in women with HIV is complicated not only by HIV infection itself but also by the medical and psychosocial comorbidities associated with HIV.