A baby is not born with Acquired Immunodeficiency Syndrome (AIDS), but rather can be born with Human Immunodeficiency Virus (HIV) if the virus transmits from the mother. AIDS is the advanced stage of HIV infection, which develops over time if HIV is not treated. HIV is a virus that can be passed from a mother to her child during pregnancy, childbirth, or breastfeeding. However, significant medical advancements, particularly in antiretroviral therapy (ART), have drastically reduced the risk of this transmission.
Understanding HIV and AIDS in Infants
Human Immunodeficiency Virus (HIV) is a virus that attacks the body’s immune system, targeting CD4 cells, a type of white blood cell crucial for fighting infections. This weakens the immune system, making the body vulnerable to illnesses. Without treatment, HIV infection progresses through stages, eventually leading to Acquired Immunodeficiency Syndrome (AIDS).
AIDS is the most severe stage of HIV infection, characterized by a severely compromised immune system and opportunistic infections or certain cancers. When an infant is born with HIV, they have the virus itself, not AIDS. AIDS only develops if the HIV infection goes untreated, allowing the virus to continuously replicate and damage the immune system over months or years. The developing immune system of an infant is particularly vulnerable to the effects of HIV, which makes early diagnosis and intervention important.
How HIV Transmits from Mother to Child
Mother-to-child transmission (MTCT) of HIV can occur during three primary periods: pregnancy, childbirth, and breastfeeding. Without any interventions, the rate of transmission can range from 15% to 45%.
During pregnancy, HIV can cross the placenta, a temporary organ connecting the mother to the fetus. While the placenta normally acts as a protective barrier, HIV-infected cells or the virus can sometimes pass through. Factors such as high maternal viral load or placental damage can increase this risk.
The majority of mother-to-child transmissions occur during childbirth. During vaginal delivery, the baby can be exposed to the mother’s blood, vaginal fluids, and cervical secretions that contain the virus. Factors like prolonged labor or invasive procedures can increase exposure.
Transmission can also occur after birth through breastfeeding. HIV can be present in breast milk. The risk increases with breastfeeding duration, especially if the mother acquires HIV during this period due to a high viral load.
Preventing Mother-to-Child HIV Transmission
Significant medical advancements have made it possible to dramatically reduce the risk of mother-to-child HIV transmission to less than 1% in many settings. This success is largely due to comprehensive prevention strategies, primarily involving antiretroviral therapy (ART) for the pregnant individual and their newborn. ART works by reducing the amount of HIV in the mother’s body, known as the viral load.
Pregnant individuals living with HIV are recommended to start ART as early as possible during pregnancy. Consistent adherence to ART throughout pregnancy, labor, and delivery can suppress the viral load to undetectable levels, effectively preventing transmission. Some ART medications can also cross the placenta, providing a protective effect to the developing fetus.
Delivery practices are carefully considered to minimize the baby’s exposure to the virus. For pregnant individuals with a consistently suppressed viral load on ART, a vaginal delivery is generally considered safe. However, if the viral load is high or unknown near delivery, an elective cesarean section (C-section) may be recommended to reduce the risk of transmission by avoiding exposure to maternal blood and fluids in the birth canal.
After birth, newborns exposed to HIV receive prophylactic ART, typically within six hours of delivery. For infant feeding, formula feeding is recommended in settings where it is safe and feasible, as it eliminates the risk of HIV transmission through breast milk. If formula feeding is not safe or accessible, or if the mother chooses to breastfeed, continued maternal ART with an undetectable viral load significantly reduces the risk, though it does not eliminate it.
Diagnosis and Management for Infants
Diagnosing HIV in infants born to mothers living with HIV requires specific tests because maternal antibodies can cross the placenta, making standard antibody tests unreliable. Instead, virologic tests, such as HIV DNA PCR tests, are used to detect the virus’s genetic material directly.
Typically, virologic tests are performed at or near birth, often within 48 hours, then again at 1-2 months, and a final test at 4-6 months. An HIV diagnosis in an infant is confirmed by two positive virologic test results from different blood samples. Early diagnosis is crucial for initiating timely treatment and improving health outcomes for the infant.
If an infant tests positive for HIV, antiretroviral therapy (ART) is initiated as soon as possible. Early ART aims to suppress the virus, preserve the infant’s immune function, and prevent the progression to AIDS. Infants typically receive a combination of at least three antiretroviral drugs.
Ongoing management involves regular monitoring of the infant’s viral load and immune status, along with specialized pediatric care for potential complications or opportunistic infections. The goal of ART in infants is to achieve and maintain viral suppression, which allows the child to live a long and healthy life.