HIV is a virus that targets the immune system, making it more difficult for the body to prevent infections and diseases. A person can transmit HIV through blood and some bodily fluids, and a pregnant person can pass the virus to the unborn child. However, following guidelines can help a person prevent transmission during pregnancy and birth in most cases.

A pregnant person can transmit HIV to their unborn child at any time during pregnancy, childbirth, and while breastfeeding. This is known as perinatal transmission. Potential complications for infants with untreated HIV can include recurrent infections, heart issues, problems with their organs, delay in growth, and low IQ.

However, many pregnant people can have healthy, HIV-negative infants with good prenatal care and screening. By working with healthcare professionals and following guidelines, 99% of HIV-positive pregnant people will not pass on the virus to their babies.

This article explores the risk of passing HIV onto an infant, how a person can lower transmission risk, and treatment options available for HIV-positive pregnant people and infants.

An infant born to a parent with HIV.Share on Pinterest
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According to the Centers for Disease Control and Prevention (CDC), less than 1% of new HIV diagnoses in the United States in 2018 were due to perinatal transmission. While it is unclear how many people with HIV give birth annually, according to a 2018 study, the number of individuals with HIV giving birth at the time was 5,000.

HIV and AIDS charity organization Avert suggests the risk of a pregnant person living with HIV passing on the virus to their infant is 15–45% if neither the pregnant person nor the infant is receiving HIV treatment. However, Avert adds that taking treatment correctly during pregnancy and breastfeeding can virtually eliminate the risk of transmitting HIV.

A person living with HIV may require extra antenatal care, such as from an HIV clinic as well as their obstetrician. This may include taking HIV medication called antiretrovirals, making preparations for a certain delivery method, and further advice on feeding methods.

A person may require antiretroviral therapy (ART) to reduce their viral load to ensure the virus does not pass to the unborn child. A viral load refers to the amount of virus per milliliter (ml) of blood in a person. ART can suppress the amount of HIV in the body, even to a point where the viral load is undetectable on tests. Viral suppression is when there are less than 200 copies of HIV per ml of blood.

There is currently no cure for HIV. However, a person can treat and manage HIV with medication.

HIV can pass from the pregnant person to the fetus through the placenta. The placenta is the organ in the uterus that provides the fetus with nutrients and removes waste products. Antiretrovirals reduce the viral load of HIV in the body and can reduce the risk of the virus passing to the fetus.

The American College of Obstetrics and Gynecologists (ACOG) recommends the following guidelines for people to reduce the risk of passing HIV to their infant:

  • taking a combination of antiretrovirals during the pregnancy
  • delivering the baby by cesarean if the HIV level in the body is high
  • taking HIV medication during labor and delivery
  • giving HIV medication to the baby after birth
  • choosing not to breastfeed

According to ACOG, 99% of HIV-positive people will not pass HIV to their infants if they follow these guidelines.

Most HIV treatment is safe to use during pregnancy. Generally, pregnant people with HIV can use the same HIV treatment recommended for non-pregnant people unless the side effects outweigh the benefits to the infant.

However, a person who is pregnant and taking HIV medication may experience some side effects. Common side effects can include:

Less common side effects may include:

  • anemia
  • liver damage
  • bone problems

According to the National Institute of Health (NIH), all HIV-positive pregnant people should start taking HIV medication as soon as possible during pregnancy.

Some HIV medications may not be suitable for use during pregnancy due to possible effects on the fetus. A doctor will consider factors such as adverse effects, drug interactions, and available pregnancy safety data before making recommendations.

A 2020 report suggests that newer HIV medications, such as dolutegravir and emtricitabine, are safer and most effective during pregnancy. However, a doctor will discuss medications and help choose the most suitable option.

HIV can pass to the infant during birth, and the delivery method may impact the risk. However, if a pregnant person has a low viral load or an undetectable viral load, a vaginal delivery is safe.

If a person has an unknown or high viral load, ACOG recommends a cesarean delivery. A cesarean delivery involves making a cut in the abdomen and uterus to deliver the baby.

However, having a cesarean delivery also carries other risks if a person is HIV-positive. A person who is HIV-positive may have a low CD4 cell count, which indicates a weak immune system. Therefore, they may be at greater risk of infection after cesarean delivery.

Infants born to people who are HIV-positive are tested for HIV many times in the first few months of life. The test will look for the presence of HIV in the infant’s blood. If two of the test results are positive, this suggests an HIV infection. Conversely, the baby will not have an HIV infection if two test results are negative. A medical professional will perform another HIV test when the baby is 12–18 months old.

An infant who is HIV-positive will receive ART. Early ART introduction can decrease the risk of infections, disease progression to AIDS, and viral load.

Recommendations also include that a person who is HIV-positive does not breastfeed as they can transmit the virus through breast milk. It is also advisable that a person who is HIV-positive does not pre-chew an infant’s food.

The CDC recommends that people considering pregnancy or those already pregnant test for HIV as soon as possible.

If a person is HIV-negative, but their partner is HIV-positive, the CDC also suggests that they should consider getting preventative HIV medication known as pre-exposure prophylaxis (PrEP).

When an individual is living with HIV and considering pregnancy but not already taking ART, it is advisable to begin the treatment to lower their viral load.

HIV is a virus that attacks and weakens the immune system, making it harder to fight infections and diseases. An HIV-positive person can transmit the virus to their unborn child during pregnancy, delivery, or while breastfeeding.

Following guidelines can help a person lower the risk of transmitting HIV to an infant. This typically involves taking ART, formula feeding instead of breastfeeding, and considering a cesarean delivery if viral load is high or unknown. Vaginal delivery is suitable if a person’s viral load is sufficiently low or undetectable.

An infant may require ART if they test positive for HIV after birth. ART will be necessary soon after birth to ensure their viral load is low.

A person considering pregnancy should either undergo testing for HIV or begin ART if they are aware that they are HIV-positive.