Last reviewed: 25 Dec 2021
Last updated: 06 Apr 2021



History and exam

Key diagnostic factors

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

Other diagnostic factors

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

Risk factors

  • needle-sharing with injection drug use
  • 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 (perinatal transmission)
  • violence against women and girls
  • receptive oral intercourse
  • insertive oral intercourse
  • multiple sexual partners
  • low maternal CD4 count (perinatal transmission)

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)

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)
  • tests for coinfections
  • drug resistance test (genotyping)
  • complete blood count
  • glucose screening
  • fetal ultrasound

Treatment algorithm



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




RKS declares that she is a principal investigator on a Gilead Investigator Sponsored Research Award through MedStar Health Research Institute.


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.


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




AS declares that she has no competing interests.

Graham P. Taylor, MBChB, FRCP, FHEA

Reader in Communicable Diseases

Faculty of Medicine

Imperial College




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.

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