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HIV and Pregnant Women, Infants, and Children

Perinatal HIV transmission (also known as mother-to-child transmission) can happen at any time during pregnancy, childbirth, and breastfeeding. However, today there are effective interventions for preventing perinatal HIV transmission, and the number of infants with HIV in the United States has declined dramatically.

graphic of a bottle of pills

 

All women who are pregnant or planning to get pregnant should take an HIV test as soon as possible. The earlier HIV is diagnosed and treated, the more effective HIV medicine (antiretroviral therapy, or ART) will be at preventing transmission.

Preventing Perinatal HIV Transmission

Advances in HIV research, prevention, and treatment have made it possible for many women with HIV to give birth to babies who are free of HIV. The annual number of HIV infections through perinatal transmission has declined by more than 95% since the early 1990s.

The first bullet is an image of a nurse icon against a yellow background. Text reads visit your health care provider regularly. The second bullet is an image of two pills against a light blue background. Text reads take HIV medicine as prescribed to stay healthy, protect your partner, and protect your baby. Taking HIV medicine reduces the amount of HIV in the body (viral load) to a very low level, called viral suppression or undetectable viral load. Getting and keeping an undetectable viral load is the best thing you can do to stay healthy and protect your baby. The third bullet is an image of 1% against a teal background. Text reads the risk of transmitting HIV to your baby can be 1% or less if you take HIV medicine as prescribed throughout pregnancy, labor, and delivery. Give HIV medicine to your baby for 4-6 weeks after giving birth. The fourth bullet is an image of a pregnant woman against a red background. Text reads if your HIV viral load is not adequately reduced, a Caesarean delivery can also help prevent HIV transmission.  The fifth bullet is an image of a baby bottle against a purple background. Text reads do not breastfeed or pre-chew your baby’s food. Keeping an undetectable viral load substantially reduces, but does not eliminate, the risk of transmitting HIV through breastfeeding. The current recommendation in the US is that mother’s with HIV should not breastfeed their babies.

*Viral suppression is defined as having less than 200 copies of HIV per milliliter of blood. An undetectable viral load means having a viral load so low that a test can’t detect it. The benefits of having an undetectable viral load also apply to people who stay virally suppressed.

All women who are pregnant or trying to get pregnant should encourage their partners to also get tested for HIV.

  • HIV-negative women who have a partner with HIV 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.
  • If either partner has HIV, that partner should take HIV medicine daily as prescribed to stay healthy and prevent transmission.
graphic of a pill bottle

 

People with HIV who take HIV medicine as prescribed and get and keep an undetectable viral load (or stay virally suppressed) have effectively no risk of transmitting HIV to their HIV-negative sexual partners.

For babies with HIV, starting treatment early is important because the disease can progress more quickly in children than adults. Providing HIV medicine early can help children with perinatal HIV live longer, healthier lives.

The Numbers

Perinatal HIV Transmission

  • We don’t know exactly how many women with HIV give birth annually in the United States. An estimate for 2006 suggested that approximately 8,500 women with HIV were giving birth annually. More recent evidence suggests that the number is less than 5,000.
  • In 2017, 73 children under the age of 13 received a diagnosis of perinatally acquired HIV in the United States and dependent areas.a

Diagnoses of Perinatal HIV Infections in the US and Dependent Areas by Race/Ethnicity, 2017

Pie chart shows diagnoses of perinatal HIV infections in the US by race/ethnicity, 2017: Black/African American=64%, White=12%, Hispanic/Latino=14%, Multiple Races=7%, Asian=1%

Source: CDC. Diagnoses of HIV infection in the United States and dependent areas. HIV Surveillance Report 2017;29.
Hispanics/Latinos can be of any race.

Diagnoses of Perinatal HIV Infections in the US and Dependent Areas

From 2012 to 2016, perinatal diagnoses: decreased 41%

Source: CDC. Diagnoses of HIV infection in the United States and dependent areas, 2017. HIV Surveillance Report 2017;29.

Rates of Perinatally Acquired HIV Infections by Year of Birth and Mother’s Race/Ethnicity, 2010-2015

Graph shows rates of perinatally acquired HIV infections by year of birth and mother’s race/ethnicity, 2010-2015: 2010: Black =6.6, Hispanic =1.7, White =0.4. 2011, Black=6.2, Hispanic=1.4, White=0.0. 2012: Black-=9.1, Hispanic=0.9, White=0.2. 2013: Black=4.8, Hispanic=0.8, White=0.2. 2014: Black=5.8, Hispanic=0.7, White=0.2. 2015: Black/AA=5.4, H/L=0.9, White=0.4.

Source: Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas, 2016. HIV Surveillance Supplemental Report 2018;23(4).
Data include only persons born in the United States (50 states and District of Columbia). Data accounted for delays between birth and diagnosis, as well as between diagnosis and reporting.
Rates are per 100,000 live births.
Live-birth data reflect race/ethnicity of the infant’s mother.
Hispanics/Latinos can be of any race.

Living With HIV

In the US and dependent areas:

  • At the end of 2016, 1,814 childrenb were living with diagnosed perinatal HIV. Of these 1,139 (63%) were black/African American, 269 (15%) were Hispanic/Latino,c and 195 (11%) were white.
  • At the end of 2016, 10,101 adults and adolescents (aged 13 and older) were living with diagnosed HIV acquired through perinatal transmission. Of these, 57% (5,757) were black/African American, 26% (2,591) were Hispanic/Latino, and 11% (1,135) were white.

Prevention Challenges

  • Pregnant women with HIV may not know they have the virus. 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 [80081]. This allows prenatal care providers to order just one panel that includes many standard serologic tests for pregnant women, including HIV.
  • Women with HIV may not know they are pregnant, how to prevent or safely plan a pregnancy, or what they can do to keep their baby from getting HIV.
  • To get the full protective benefit of HIV medicine, the mother needs to take it as prescribed—without interruption—throughout pregnancy and childbirth, and provide HIV medicine to her infant. Pregnant women 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 health care, and disproportionately affect people living with HIV. Pregnant women with HIV may face more barriers to accessing medical care and staying on treatment if they also inject drugs, use other substances, are experiencing homelessness, or are incarcerated, mentally ill, or uninsured.

What CDC Is Doing

photo of a young girl hugging a pregnant woman
  • 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. These are the goals that CDC has developed for elimination of mother-to-child HIV transmission in the United States.
  • CDC supports CityMatCH to convene a group of stakeholders including public health professionals and clinical care providers to implement the CDC framework.
  • 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.

a American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, the Republic of Palau, and the US Virgin Islands.
b Children under the age of 13.
c Hispanics/Latinos can be of any race.

Bibliography

  1. CDC. Diagnoses of HIV infection in the United States and dependent areas, 2017. HIV Surveillance Report 2018;29.
  2. CDC. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas—2017. HIV Surveillance Supplemental Report 2016;23(4).
  3. Nesheim SR, FitzHarris LF, Lampe MA, Gray KM. Reconsidering the number of women with HIV infection who give birth annually in the United States. Public Health Rep 2018;133(6):637-43. PubMed abstract.
  4. 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;36(1):66-71.
  5. Panel on Treatment of HIV-infected Pregnant Women and Prevention of Perinatal Transmission. Recommendations for the use of antiretroviral drugs in pregnant women with HIV infection and interventions to reduce prenatal HIV transmission in the United States. AIDSinfo 2018.
  6. CDC. Pediatric HIV surveillance (through 2017) [slides]. Accessed January 3, 2019.
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  8. CDC. Achievements in public health: reduction in perinatal transmission of HIV infection—United States, 1985–2005. MMWR 2006;55(21):592-7.
  9. Fleming PL, Lindegren ML, Byers R, et al. Estimated number of perinatal HIV infections, U.S., 2000. Poster presented at: XIV International AIDS Conference; July 7-12, 2002; Barcelona, Italy.
  10. 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(3):218-22. Pubmed abstract.
  11. 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. Paper presented at: 6th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention; July 17-20, 2011; Rome, Italy.
  12. 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;129(1):74-81.
  13. Taylor AW, Nesheim S, Whitmore S, et al. Estimated number and characteristics associated with perinatal HIV infections, 33 states, United States, 2003–2007. Paper presented at: 6th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention. July 17-20, 2011; Rome, Italy.
  14. CDC. Branson B, Handsfield HH, Lampe MA, Janssen RS, Taylor AW, Lyss SB, Clark JE. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR 2006;55(RR-14):1-17.
  15. 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.
  16. 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(2):658-66.
  17. 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(6):488.e1-8.
  18. 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;210(10);1529-38.
  19. Nesheim SR, Wiener J, FitzHarris L, Lampe MA, Wiedle PJ. Brief report: estimated incidence of perinatally acquired HIV infection in the United States, 1978–2013; J Acquir Immune Defic Syndr 2017;76:461-4.

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