Perinatal transmission of HIV is a serious concern for pregnant people with HIV. An HIV-positive person can transmit the virus to the child through breastfeeding, childbirth, or pregnancy.

Even today, over 40 years after its discovery, HIV is a significant public health concern in the United States. With 1.2 million people living with HIV, it is essential to understand how to prevent transmission.

Blood, semen, pre-seminal fluid, vaginal fluids, and breast milk can carry and transmit HIV.

The risk of transmission depends on the person’s viral load. So people living with HIV who are pregnant or planning to become pregnant soon must talk with their doctor about taking antiretroviral drugs and other methods to help prevent HIV transmission. The goal is to reduce the chances of passing on HIV to the infant as much as possible.

This article explores the perinatal transmission of HIV, how often it occurs, and factors that increase the risk. It also looks at breastfeeding with HIV and what happens if a baby tests positive.

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Perinatal transmission occurs when a pregnant person transfers a virus to their baby during pregnancy, labor, or delivery or through breast milk when breastfeeding.

Yes, perinatal transmission can occur with HIV. The virus may spread to babies during pregnancy, childbirth, or when breastfeeding. It can transfer through the blood, vaginal fluids, and breast milk.

Perinatal transmission is preventable. It is possible for people who have HIV to give birth without transmitting HIV to their infants. In fact, the amount of perinatal transmission HIV cases has decreased by more than 95% since early in the 1990s. In 2018, less than 1% of all new HIV cases were due to perinatal transmission.

So it is possible to prevent transmission of HIV, but people must be proactive and follow the recommended steps.

1. Visit a physician

People who are expecting should visit their doctor regularly to monitor their HIV viral load, which is the amount of HIV in their body. Healthcare professionals can also help make sure that the pregnant person is taking their HIV medicine as prescribed.

2. Take HIV medicine

When someone with HIV finds out that they are pregnant, they begin taking antiretroviral medication. Taking this medication reduces the risk of perinatal transmission by two-thirds. It does this by reducing the amount of HIV in a person’s body to an extremely low level. Doctors also refer to this level as viral suppression or an undetectable viral load.

This step is the most important in terms of helping prevent transmission to the baby.

The baby also takes the medication following birth to reduce the risk of HIV transmission. They take these drugs every 6 hours for the first 6 weeks of their life.

3. Have a cesarean delivery

A doctor may recommend a cesarean delivery or cesarean section (C-section) for people who cannot lower their viral load enough through HIV medicine. Giving birth in this manner helps to prevent HIV transmission.

4. Refrain from breastfeeding

While maintaining an undetectable viral load considerably reduces the likelihood of transmitting HIV through breastfeeding, it does not eliminate the risk entirely.

Because of this, the Centers for Disease Control and Prevention (CDC) encourage people with HIV to refrain from breastfeeding their babies. In addition, it is also crucial that those with HIV do not pre-chew their baby’s food, as this can also serve as a potential transmission method.

Various factors may increase the risk of transmission.

One such factor is genetics, which can play a role in the likelihood of perinatal transmission. Another factor is the infection of other illnesses in either the parent or child. These diseases include malaria and tuberculosis, among others.

Additional risk factors involve behavior and lifestyle choices. For the parent, this can include non-prescription drug use while pregnant and the frequency of sexual intercourse during pregnancy. It can also include the number of sex partners throughout the pregnancy.

Once the child is born, the chosen method of feeding — whether breastfeeding, mixed feeding, or chewing the food for the baby — can impact the risk of HIV transmission.

The final set of risk factors involves the nutritional status of the pregnant person. This can include:

  • advanced disease with malnutrition and immunosuppression
  • sexually transmitted infections (STIs)
  • vitamin A deficiency, or other types of micronutrient deficiencies

All of these health conditions play a role in increased perinatal transmission risk.

While HIV medicine can reduce viral load to a minimal level, there is still a chance of transmitting HIV through breastfeeding. Since there is still a negligible risk, the CDC recommends that all people with HIV find alternative ways to feed their babies.

A person can talk with their doctor about different options for feeding their baby.

Some alternatives to breastfeeding include baby formula or donor milk. Both options are great ways to provide a baby with all the nutritional value they need without risking perinatal transmission.

Once the baby begins showing signs and tests positive for HIV, it is essential to start treatment early to help prevent the HIV condition from progressing.

Treatment for HIV involves antiretroviral therapy. Because the treatment does not cure the condition, the child will need to take these medications for the rest of their life. It is also crucial that they take their medicine every day, or the treatment may not be effective.

By taking medicine as instructed, children with HIV can expect to live nearly as long as someone without HIV.

Not treating an infant with HIV results in a child with an immune system that weakens over time. Because of this, children with HIV may develop severe infections that are uncommon in healthy children.

It is essential for expecting parents with HIV to reach out to a doctor when they know they are pregnant. Then, doctors can start them on antiretroviral medications if they are not already taking them and can help prevent perinatal transmission.

The CDC recommends that even people who believe they do not have HIV should test for it, because not all people know that they have it. In addition, the sooner the person has their diagnosis, the sooner they can begin taking medicine to reduce their viral load.

Perinatal transmission is likely in people with HIV and involves transferring HIV to their baby through pregnancy, childbirth, or breastfeeding.

Actions such as taking antiretroviral drugs, having a planned C-section, and not breastfeeding can help to reduce the risk of perinatal transmission. It is also helpful for people to understand the risk factors that increase the possibility of transmission.

Children who contract HIV need to begin treatment right away to help prevent the condition from progressing. While they will be on these medications for the rest of their lives, they can expect to have a nearly average life span.