Mother-to-Child HIV Transmission: Cases of Missed Opportunities

HIV infecting cell
HIV infecting cell
A small portion of HIV-infected women transmit the virus to their neonates despite high-quality care.

HealthDay News — A small proportion of HIV-infected women continue to transmit the virus to their neonates despite access to high-quality care, according to research published in Obstetrics & Gynecology.

Gwendolyn B. Scott, MD, from the University of Miami Miller School of Medicine, and colleagues examined data relating to HIV-infected children born from 2002 to 2009 to HIV-infected women. The authors describe the characteristics of the HIV-infected infants and their mothers, as well as mother’s clinical management.

The researchers identified 12 cases of mother-to-child HIV transmission among 1,857 liveborn neonates (prevalence, 0.65 per 100 live births to HIV-infected women). Transmission was in utero for 4 neonates, peripartum for 3 neonates, and unable to be determined for 5 neonates. 

None of the infants were breastfed. Near delivery, 7 of the women had plasma viral loads >400 copies/mL. During pregnancy, 6 women had less than 11 weeks of antiretroviral therapy; 3 of these women had premature deliveries. One woman was diagnosed with HIV postpartum and received no antiretroviral therapy during pregnancy. Poor-to-moderate adherence to antiretroviral therapy was reported for 6 mothers. Preterm delivery occurred in 4 of 5 mothers with viral loads >1,000 copies/mL. Five women were delivered by cesarean, including four non-elective cesarean deliveries.

“This case series provides insight into factors contributing to HIV perinatal transmission and can inform the development of new strategies for prevention of mother-to-child transmission of HIV,” the researchers write.

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Scott GB, Brogly SB, Muenz D, Stek AM, Read JS; International Maternal Pediatric Adolescent AIDS Clinical Trials Group (IMPAACT) P1025 Study Team. Missed opportunities for prevention of mother-to-child transmission of human immunodeficiency virus. Obstet Gynecol. 2017;129:621-628. doi: 10.1097/AOG.0000000000001929