HIV infection in pregnancy

Last reviewed: 26 Aug 2022
Last updated: 23 Mar 2022

Summary

Definition

History and exam

Key diagnostic factors

  • increased risk of maternal HIV infection
  • increased risk of perinatal HIV transmission
More key diagnostic factors

Other diagnostic factors

  • oral candidiasis
  • increasing dyspnoea
  • weight loss
  • fever
  • malaise
  • lymphadenopathy
  • maculopapular blanching rash
Other diagnostic factors

Risk factors

  • needle-sharing with injection drug use
  • receptive penile-vaginal intercourse
  • unprotected receptive anal intercourse
  • percutaneous needle prick
  • sexually transmitted infections (STIs) and bacterial vaginosis
  • high maternal viral load (perinatal transmission)
  • absence of antenatal maternal antiretroviral therapy (perinatal transmission)
  • breastfeeding (perinatal transmission)
  • violence against women and girls
  • receptive oral intercourse
  • insertive oral intercourse
  • multiple sexual partners
  • low maternal CD4 count (perinatal transmission)
More risk factors

Diagnostic investigations

1st investigations to order

  • 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)
More 1st investigations to order

Investigations to consider

  • 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 test (genotyping)
  • full blood count
  • glucose screening
  • fetal ultrasound
  • tests for co-infections
More investigations to consider

Treatment algorithm

ACUTE

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

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

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

infants born to HIV-infected mothers

Contributors

Authors

Rachel K. Scott, MD, MPH, FACOG

Assistant 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 and Director

Women's Center for Positive Living

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

Washington

DC

Disclosures

RKS declares that she is an investigator on ViiV and Gilead Investigator Sponsored Research Awards managed through MedStar Health Research Institute.

Acknowledgements

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.

Disclosures

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

Peer reviewers

Aisha Sethi, MD

Assistant Professor of Medicine

Associate Residency Program Director

University of Chicago

Chicago

IL

Disclosures

AS declares that she has no competing interests.

Graham P. Taylor, MBChB, FRCP, FHEA

Reader in Communicable Diseases

Faculty of Medicine

Imperial College

London

UK

Disclosures

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.

  • Differentials

    • Infectious mononucleosis
    • Toxoplasmosis
    • Viral hepatitis
    More Differentials
  • Guidelines

    • Recommendations for the use of antiretroviral drugs during pregnancy and interventions to reduce perinatal HIV transmission in the United States
    • Sexually transmitted infections treatment guidelines
    More Guidelines
  • Patient leaflets

    HIV infection in pregnancy

    More Patient leaflets
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