Prevention of Mother-to-Child HIV Transmission

Introduction to Prevention Strategies

• The American Academy of Pediatrics recommends universal HIV testing of pregnant women, early initiation of antiretroviral therapy (ART) during pregnancy, appropriate delivery methods, and proper infant feeding practices based on resource availability 1, 2

Maternal HIV Testing and Prevention

• Universal HIV testing should be performed for all pregnant women using an "opt-out" consent approach, with repeat testing in the third trimester for high-risk women 1, 3
• For women in labor with undocumented HIV status, rapid HIV testing should be performed immediately with results available within 12 hours of birth 1, 4

Antiretroviral Interventions During Pregnancy

• HIV-infected pregnant women should receive combination antiretroviral therapy (ART) as early as possible in pregnancy, ideally before conception 5, 2
• Without ART intervention, HIV-infected pregnant women have a 15-45% risk of transmitting the virus to their child; with effective ART, this risk can be reduced to less than 5% 6, 2

Intrapartum Management

• Elective cesarean delivery at 38 weeks is recommended for HIV-infected women with viral loads >1000 copies/mL near delivery time or unknown viral load, reducing transmission risk by approximately 50% 8

Infant Prophylaxis and Care

• All infants born to HIV-infected mothers should receive antiretroviral prophylaxis, typically with zidovudine for 6 weeks 1, 4
• For high-risk scenarios (mothers with no prenatal ART or poor viral suppression), experts may recommend additional antiretroviral drugs beyond zidovudine alone 8

Infant Feeding Recommendations

• In resource-rich settings, HIV-infected women should not breastfeed regardless of maternal ART use, as safe feeding alternatives exist 9, 8
• In resource-limited settings, the WHO recommends HIV-infected mothers should breastfeed for at least 12 months while being fully supported for ART adherence 5, 6

Nutritional Support for HIV-Infected Children

• Management of severe acute malnutrition (SAM) in HIV-infected children follows a two-phase approach: stabilization and rehabilitation 5, 6
• During stabilization, F-75 (a low-protein, milk-based therapeutic diet) should be administered 6

Follow-up Care for HIV-Exposed Infants

• All HIV-exposed infants should receive appropriate testing to determine infection status 4, 8
• Prophylaxis against Pneumocystis jiroveci pneumonia should be provided for infants with undetermined or positive HIV status 8

Common Pitfalls and Caveats

• Failure to test pregnant women for HIV is the most significant missed opportunity for prevention 1, 3
• Delayed initiation of antiretroviral therapy significantly reduces effectiveness of prevention 5, 2
• Inconsistent adherence to maternal ART during pregnancy and breastfeeding increases transmission risk 5, 6