HIV infection in pregnancy

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Última revisão: 16 Aug 2025

Última atualização: 05 Feb 2025

Human immunodeficiency virus (HIV) infection in pregnancy not only poses a threat to maternal immune health, but can lead to transmission of HIV in utero, intrapartum, or through breast-feeding postpartum.

All pregnant women should be tested for HIV as early as possible in pregnancy. Repeat testing is recommended in the third trimester for pregnant women with initial negative tests who have high potential HIV exposure, live in an area with a high HIV prevalence, or receive care at a facility with a high HIV incidence.

HIV-exposed infants should be tested for HIV infection at birth and seek specialty care for follow-up testing and treatment.

All pregnant women with HIV should receive antiretroviral therapy (ART), as early as possible in the pregnancy, regardless of CD4 count or viral load. ART should be prescribed continuously during the antepartum, intrapartum, and postpartum periods, as well as prophylaxis for the neonate.

Evidence-based, patient-centered counseling regarding breast-feeding and replacement feeding is recommended to inform shared decision-making.

Definición

HIV is a retrovirus that causes HIV infection by infecting CD4 T cells and can lead to acquired immunodeficiency syndrome.[1] Pregnancy in women with HIV is complicated not only by HIV infection itself but also by the medical and psychosocial comorbidities associated with HIV.

Anamnesis y examen

Principales factores de diagnóstico

increased risk of maternal HIV infection
increased risk of perinatal HIV transmission

Todos los datos

Otros factores de diagnóstico

oral candidiasis
increasing dyspnea
weight loss
fever
malaise
lymphadenopathy
maculopapular blanching rash

Todos los datos

Factores de riesgo

needle-sharing with injection drug use
unprotected receptive penile-vaginal intercourse
unprotected receptive anal intercourse
percutaneous needle stick
sexually transmitted infections (STIs) and bacterial vaginosis
high maternal viral load (perinatal transmission)
absence of prenatal maternal antiretroviral therapy (perinatal transmission)
breast-feeding in mothers without viral suppression (perinatal transmission)
violence against women and girls
receptive oral intercourse
insertive oral intercourse
multiple sexual partners
low maternal CD4 count (perinatal transmission)

Todos los datos

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

maternal HIV-1/HIV-2 antigen/antibody enzyme-linked immunosorbent assay (ELISA)
maternal HIV-1/HIV-2 antibody differentiation immunoassay
neonatal HIV DNA or RNA polymerase chain reaction (PCR)

Todos los datos

Pruebas diagnósticas que deben considerarse

HIV-1 western blot
HIV-1 indirect immunofluorescence assay (IFA)
HIV-1 nucleic acid test (NAT)
CD4 count
plasma HIV RNA levels (viral load)
renal function tests
liver function tests (LFTs)
drug resistance tests
complete blood count
glucose screening
fetal ultrasound
tests for coinfections

Todos los datos

Algoritmo de tratamiento

Agudo

HIV-1-infected pregnant women: <38 weeks not in labor (regardless of HIV RNA level)

HIV-1-infected pregnant women with HIV-1 RNA levels >1000 copies/mL: at 38 weeks or in labor

HIV-1-infected pregnant women with HIV-1 RNA levels ≤1000 copies/mL: at 38 weeks or in labor

infants born to HIV-infected mothers

Colaboradores

Autores

Rachel K. Scott, MD, MPH, FACOG

Associate Professor of Obstetrics and Gynecology

Georgetown University School of Medicine

Scientific Director of Women’s Health Research

MedStar Health Research Institute

Associate Chair for Research

MedStar Washington Hospital Center Department of Women’s and Infants’ Services

Washington

Divulgaciones

RKS declares that she has participated in an advisory meeting for ViiV Healthcare and has received research funding from ViiV, managed by MedStar Health Institute.

Agradecimientos

Dr Rachel K. Scott would like to gratefully acknowledge Dr Isaac Delke, Dr Christina Bailey, and Dr Mettassebia Kano, the previous contributors to this topic.

Divulgaciones

ID, CB, and MK declare that they have no competing interests.

Revisores por pares

Aisha Sethi, MD

Assistant Professor of Medicine

Associate Residency Program Director

University of Chicago

Chicago

Divulgaciones

AS declares that she has no competing interests.

Graham P. Taylor, MBChB, FRCP, FHEA

Reader in Communicable Diseases

Faculty of Medicine

Imperial College

London

Divulgaciones

GPT has been reimbursed by various pharmaceutical companies for attending conferences, lecturing, and consulting, and has been chief investigator of investigator-initiated industry-funded research on HIV and pregnancy.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referencias

Nuestros equipos internos de evidencia y editoriales colaboran con colaboradores expertos internacionales y revisores pares para garantizar que brindemos acceso a la información más clínicamente relevante posible.

Artículos principales

Panel on Treatment of HIV During Pregnancy and Prevention of Perinatal Transmission. Recommendations for the use of antiretroviral drugs during pregnancy and interventions to reduce perinatal HIV transmission in the United States. Jan 2024 [internet publication].Texto completo

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.

Diagnósticos diferenciais
- Infectious mononucleosis
- Toxoplasmosis
- Viral hepatitis
Mais Diagnósticos diferenciais
Diretrizes
- Recommendations for the use of antiretroviral drugs during pregnancy and interventions to reduce perinatal HIV transmission in the United States
- Care of pregnant women living with HIV and interventions to reduce perinatal transmission
Mais Diretrizes
Folhetos informativos para os pacientes
HIV infection in pregnancy
Mais Folhetos informativos para os pacientes
Conectar-se ou assinar para acessar todo o BMJ Best Practice

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HIV infection in pregnancy

Resumo

Definición

Anamnesis y examen

Principales factores de diagnóstico

Otros factores de diagnóstico

Factores de riesgo

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

Pruebas diagnósticas que deben considerarse

Algoritmo de tratamiento

HIV-1-infected pregnant women: <38 weeks not in labor (regardless of HIV RNA level)

HIV-1-infected pregnant women with HIV-1 RNA levels >1000 copies/mL: at 38 weeks or in labor

HIV-1-infected pregnant women with HIV-1 RNA levels ≤1000 copies/mL: at 38 weeks or in labor

infants born to HIV-infected mothers

Colaboradores

Autores

Rachel K. Scott, MD, MPH, FACOG

Divulgaciones

Agradecimientos

Divulgaciones

Revisores por pares

Aisha Sethi, MD

Divulgaciones

Graham P. Taylor, MBChB, FRCP, FHEA

Divulgaciones

Peer reviewer acknowledgements

Disclosures

Referencias

Artículos principales

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.

Diagnósticos diferenciais

Diretrizes

Folhetos informativos para os pacientes

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se para acessar todo o BMJ Best Practice