Preventing the transmission of HIV from mother to child is a critical public health priority. People are advised to get tested for HIV before they become pregnant or as early as possible during pregnancy, and again during the third trimester. Early detection of HIV allows for timely intervention with HIV medicines (antiretrovirals).
Understanding Perinatal Transmission of HIV
Perinatal transmission of HIV refers to the transmission of the virus from the mother or birthing parent to their child during pregnancy, childbirth (labor and delivery), or breastfeeding. This type of transmission was previously known as mother-to-child transmission of HIV.
The Role of Antiretroviral Therapy (ART)
Antiretroviral therapy (ART) is essential for preventing perinatal transmission of HIV. ART involves using a combination of HIV medicines to manage the virus. Pregnant individuals with HIV should continue ART throughout pregnancy and childbirth to significantly reduce the risk of transmission to the baby. The successful implementation of ART and other strategies has reduced the rate of perinatal transmission to 1% or less in the United States and Europe.
Delivery Methods and Viral Load Considerations
Most pregnant individuals with HIV can safely have vaginal deliveries. However, if the viral load is high (more than 1,000 copies/mL) or unknown near the time of delivery, a scheduled cesarean delivery (C-section) may be recommended to further minimize the risk of HIV transmission.
Post-Birth HIV Management for Babies
After birth, babies born to HIV-positive individuals should receive HIV medicines to reduce the risk of transmission. The specific medicines and duration of treatment depend on several factors, including the mother’s viral load and the baby’s health.
Breastfeeding and HIV Transmission
While HIV can be transmitted through breastfeeding, maintaining an undetectable viral load through consistent use of HIV medicines can lower the risk of transmission to less than 1%. Pregnant individuals with HIV should discuss feeding options with their healthcare provider to make the best decision for their situation.
HIV Testing Recommendations for Pregnant Individuals
The Centers for Disease Control and Prevention (CDC) recommends that all individuals get tested for HIV before pregnancy, as early as possible during each pregnancy, and again in the third trimester. Early detection allows for the timely initiation of HIV medicines, which are crucial for preventing perinatal transmission.
Preventing Perinatal Transmission of HIV: Key Points
- Early HIV Testing: Pregnant individuals and those planning to conceive should get tested for HIV early and encourage their partners to do the same.
- ART Throughout Pregnancy: Consistent use of ART during pregnancy, childbirth, and breastfeeding is essential.
- Viral Load Monitoring: Keeping the viral load undetectable is crucial for reducing transmission risk.
- Safe Delivery Practices: High viral loads may necessitate a C-section to prevent transmission.
- Post-Birth Care: Newborns should receive appropriate HIV medicines to reduce transmission risk.
- Breastfeeding Options: Discuss feeding options with healthcare providers to minimize transmission risk.
Safe Use of HIV Medicines During Pregnancy
HIV medicines are safe to use during pregnancy and do not increase the risk of birth defects. Health care providers will help determine the best medication regimen for each individual, balancing the benefits and risks. If someone becomes pregnant while already on HIV medication, they should continue their regimen unless advised otherwise by their healthcare provider.
Additional Prevention Measures
In cases where the viral load is high near delivery, a C-section can reduce transmission risk. Pregnant individuals with HIV should discuss feeding options with their medical team to make informed decisions about breastfeeding versus formula feeding or using pasteurized donor human milk.
Summing Up
Preventing perinatal transmission of HIV involves early detection, consistent use of ART, careful monitoring, and informed decision-making regarding delivery and feeding practices. With these measures, the risk of transmitting HIV from mother to child can be reduced to 1% or less, ensuring healthier outcomes for both parent and child.