Print this page    •   Back to Web version of article

Mother-to-Child (Perinatal) HIV Transmission and Prevention

October 2007

HIV transmission from mother to child during pregnancy, labor and delivery, or breastfeeding is called perinatal transmission. Research published in 1994 showed that zidovudine (ZDV) given to pregnant women infected with HIV and their newborns reduced the risk for this type of HIV transmission.1 Since then, the testing of pregnant women and treatment for those who are infected have resulted in a dramatic decline in the number of children perinatally infected with HIV. However, much work remains to be done: about 100-200 infants in the United States are infected with HIV annually. Many of these infections involve women who were not tested early enough in pregnancy or who did not receive prevention services.

Perinatal HIV transmission is the most common route of HIV infection in children and is now the source of almost all AIDS cases in children in the United States. Most of the children with AIDS are members of minority races/ethnicities.2


Statistics

HIV/AIDS in 2005

The following bullets are data from the 33 states with long-term, confidential name-based HIV reporting. For a list of the 33 states, see the box at the end of this fact sheet.

AIDS in 2005

AIDS Cases Due to the Perinatal Transmission of HIV Infection, by Year of Diagnosis, 2001-2005, United States2

AIDS Cases Due to the Perinatal Transmission of HIV Infection, by Year of Diagnosis, 2001-2005, United States

Race/Ethnicity of Children (<13 Years) With AIDS Diagnosed During 2005

(includes all children with a diagnosis of AIDS, not just those who contracted HIV perinatally)

Race/Ethnicity of Children (<13 Years) With AIDS Diagnosed During 2005 (includes all children with a diagnosis of AIDS, not just those who contracted HIV perinatally)

Note. Includes children of unknown race or multiple races. Because the total is less than 100, this graph shows numbers, not percentages. No cases of AIDS were diagnosed among American Indian/Alaska Native children.


Risk Factors and Barriers to Prevention

Lack of Awareness of HIV Serostatus

The main risk factor, which is also a barrier to the prevention of perinatal HIV transmission, is lack of awareness of HIV status among pregnant women.

Uneven HIV Testing Rates

Recent CDC studies found that HIV testing rates for pregnant women varied widely and that a relatively high proportion of women of childbearing age were unaware that treatment is available to reduce the risk for perinatal transmission.6,7 In a 2002 study of HIV testing in the United States, 31% of the 748 women who had recently been pregnant reported that they had not been tested during prenatal care.8 Continued efforts are needed to ensure that all women know their HIV status as early as possible in pregnancy.


Prevention

To reduce further the incidence of HIV infection, CDC announced a new initiative, Advancing HIV Prevention (AHP), in 2003.10 This initiative comprises 4 strategies: making HIV testing a routine part of medical care, implementing new models for diagnosing HIV infections outside medical settings, preventing new infections by working with HIV-infected persons and their partners, and further decreasing perinatal HIV transmission.

In 2006, CDC published "Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings."5 To further reduce the number of children who are infected with HIV perinatally, these recommendations called for routine opt-out HIV screening for all pregnant women, with repeat HIV screening in the third trimester for women who meet 1 or more of 4 criteria (for example, women at high risk and women who receive health care in jurisdictions with elevated rates of HIV infection among women). Women whose HIV status is unknown at the time of labor should be offered opt-out screening with a rapid HIV test.

In support of these recommendations, CDC developed a social marketing campaign -- One Test. Two Lives. -- with the goal of ensuring that all women are tested for HIV early in their pregnancy. The campaign provides quick access to a variety of resources for health care providers, along with materials for their patients, to encourage universal voluntary prenatal testing for HIV. Information on this campaign can be found at www.cdc.gov/1test2lives.

Already, perinatal HIV prevention has saved lives.

CDC funds 15 state and local health departments to conduct perinatal HIV prevention programs. The following are examples of CDC-funded perinatal HIV prevention programs:

1 Opt-out HIV testing: women are told that an HIV test will be included in the standard group of prenatal tests but that they may decline HIV testing.

2 Opt-in HIV testing: women are provided pretest counseling and must specifically consent to an HIV test.

Understanding HIV and AIDS Data

AIDS surveillance: Through a uniform system, CDC receives reports of AIDS cases from all US states and dependent areas. Since the beginning of the epidemic, these data have been used to monitor trends because they are representative of all areas. The data are statistically adjusted for reporting delays and for the redistribution of cases initially reported without risk factors. As treatment has become more available, trends in new AIDS diagnoses no longer accurately represent trends in new HIV infections; these data now represent persons who are tested late in the course of HIV infection, who have limited access to care, or in whom treatment has failed.

HIV surveillance: Monitoring trends in the HIV epidemic today requires collecting information on HIV cases that have not progressed to AIDS. Areas with confidential name-based HIV infection reporting requirementsuse the same uniform system for data collection on HIV cases as for AIDS cases. A total of 33 states (Alabama, Alaska, Arizona, Arkansas, Colorado, Florida, Idaho, Indiana, Iowa, Kansas, Louisiana, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming) have collected these data for at least 5 years, providing sufficient data to monitor HIV trends and to estimate risk behaviors for HIV infection.

HIV/AIDS: This term is used to refer to 3 categories of diagnoses collectively: (1) a diagnosis of HIV infection (not AIDS), (2) a diagnosis of HIV infection and a later diagnosis of AIDS, and (3) concurrent diagnoses of HIV infection and AIDS.


References

  1. Connor EM, Sperling RS, Gelber R, et al. Reduction of maternal-infant transmission of human immunodeficiency virus type with zidovudine treatment. New England Journal of Medicine 1994;331:1173-1180.
  2. CDC. HIV/AIDS Surveillance Report, 2005. Vol. 17. Rev. ed. Atlanta: US Department of Health and Human Services, CDC; 2007:1-54.
  3. Lindegren ML, Byers RH, Thomas P, et al. Trends in perinatal transmission of HIV/AIDS in the United States. JAMA 1999;282:531-538.
  4. Marks G, Crepaz N, Janssen RS. Estimating sexual transmission of HIV from persons aware and unaware that they are infected with the virus in the USA. AIDS 2006;20(10):1447-1450.
  5. CDC. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR 2006;55(RR-14):1-17.
  6. CDC. HIV testing among pregnant women -- United States and Canada, 1998-2001. MMWR 2002;51:1013-1016.
  7. Anderson JE, Ebrahim S, Sansom S. Women's knowledge about treatment to prevent mother-to-child human immunodeficiency virus transmission. Obstetrics and Gynecology 2004;103:165-168.
  8. Anderson JE, Sansom S. HIV testing among U.S. women during prenatal care: findings from the 2002 National Survey of Family Growth. Maternal and Child Health Journal 2006;10(5):413-417.
  9. Aynalem G, Mendoza P, Mascola L, Frederick T. Trends and associated factors in timing of maternal HIV status identification: implications for preventing perinatal HIV/AIDS infection. National HIV Prevention Conference; August 2003; Atlanta. Abstract M2-B0303.
  10. CDC. Advancing HIV Prevention: New Strategies for a Changing Epidemic -- United States, 2003. MMWR 2003;52(15):329-332.
  11. McKenna MT, Hu X. Recent trends in the incidence and morbidity associated with perinatal human immunodeficiency virus infection in the United States. American Journal of Obstetrics and Gynecology 2007;197(3)(suppl 1):S10-S16.
  12. Cooper ER, Charurat M, Mofenson LM, et al. Combination antiretroviral strategies for the treatment of pregnant HIV-1-infected women and prevention of perinatal HIV-1 transmission. Journal of Acquired Immune Deficiency Syndromes 2002;29(5):484-494.
  13. Wade NA, Birkhead GS, Warren BL, et al. Abbreviated regimens of zidovudine prophylaxis and perinatal transmission of the human immunodeficiency virus. New England Journal of Medicine 1998;339(20):1409-1414.
  14. Doyle PA, Rogers P, Gerka M, et al. Implementation of a comprehensive model for recruiting pregnant women at risk for HIV and late or no prenatal care. National HIV Prevention Conference; August 2003; Atlanta. Abstract T1-C1002.
  15. Clark J, Sansom S, Simpson BJ, et al. Promising strategies for preventing perinatal HIV transmission: model programs from three states. Maternal and Child Health Journal 2006;10(4):367-373.
  16. Bryant Borders AE, Eary RL, Olszewski Y, et al. Ready or not -- intrapartum prevention of perinatal HIV transmission in Illinois. Maternal and Child Health Journal 2007;11(5):485-493.
  17. Burr CK, Lampe MA, Gross E, Clark J, Jones R. A strategic planning approach to influencing hospital practice regarding rapid HIV testing in labor and delivery. Annual Meeting of the American Public Health Association; 2007; Washington DC. Abstract 161680.




This article was provided by U.S. Centers for Disease Control and Prevention. You can find this article online by typing this address into your Web browser:
http://www.thebody.com/content/art44195.html

General Disclaimer: TheBody.com is designed for educational purposes only and is not engaged in rendering medical advice or professional services. The information provided through TheBody.com should not be used for diagnosing or treating a health problem or a disease. It is not a substitute for professional care. If you have or suspect you may have a health problem, consult your health care provider.