An HIV-positive mother can give birth to an HIV-negative child. Significant medical advancements have transformed the outlook for pregnant individuals living with HIV. The risk of HIV transmission from mother to child has been dramatically reduced due to effective prevention strategies and widespread access to testing and treatment. This progress represents a major public health success, moving towards the elimination of new pediatric HIV infections.
How HIV Can Pass to a Baby
HIV can be transmitted from a mother to her child at different stages. This transmission, known as perinatal or mother-to-child transmission (MTCT), can occur during pregnancy, labor and delivery, or through breastfeeding.
During pregnancy, the virus can cross the placenta and infect the fetus. Transmission can also happen during childbirth, as the baby may be exposed to the mother’s blood and other bodily fluids. Without any interventions, the risk of transmission can range from 15% to 45%, with breastfeeding accounting for a substantial portion of these transmissions.
Medical Interventions During Pregnancy and Birth
Early HIV testing during pregnancy is a foundational step, allowing for prompt identification of HIV and the initiation of treatment. This testing is recommended at the first prenatal visit, with additional testing in the third trimester for certain scenarios or at delivery if not previously performed.
Antiretroviral therapy (ART) for the pregnant individual is the primary strategy to prevent mother-to-child transmission. ART involves medicines that stop HIV from multiplying, significantly reducing the viral load. The goal is to achieve an “undetectable viral load,” meaning HIV levels are too low to detect. An undetectable viral load substantially lowers the risk of perinatal transmission to less than one percent.
In most cases where the viral load is undetectable, vaginal delivery is safe and recommended. A planned cesarean delivery might be considered if the mother’s viral load is high (above 1,000 copies/mL) or unknown near delivery to further reduce transmission risk. A C-section is not typically necessary for HIV prevention if the viral load is suppressed.
Care and Protection for the Newborn
After birth, specific interventions protect the newborn from HIV. All babies born to HIV-positive mothers receive antiretroviral medicines for a short period, known as post-exposure prophylaxis (PEP). This medication, often zidovudine, is given as soon as possible after delivery to protect the baby from any virus that may have passed.
Infant feeding choices are carefully considered to prevent postnatal transmission. Where safe alternatives like formula are available, formula feeding is recommended to eliminate transmission risk through breast milk. In some resource-limited settings, where safe formula feeding might not be feasible, breastfeeding with the mother on ART may be considered under strict medical guidance.
Newborns exposed to HIV undergo a series of tests to determine their HIV status. Virologic tests, which detect the virus itself, are performed at 14 to 21 days, one to two months, and four to six months. If the baby is breastfed, additional testing is conducted periodically during the breastfeeding period and after it ends to confirm the absence of the virus.
High Success Rates and Hope
Advancements in preventing mother-to-child HIV transmission have led to high success rates. When pregnant individuals adhere to antiretroviral therapy and follow recommended medical protocols, the risk of transmitting HIV to their baby can be reduced to less than one percent. This is a dramatic improvement compared to historical transmission rates of 25-45% without intervention.
These successful outcomes attest to the effectiveness of comprehensive prevention programs worldwide. Global efforts have reduced new pediatric HIV infections, averting millions since the early 2000s. The continued implementation of these strategies offers hope for a future where mother-to-child HIV transmission is virtually eliminated.