Preventing Perinatal Transmission of HIV After Birth
Key Points
- To prevent perinatal transmission of HIV after childbirth, HIV medicines should be continued postpartum and should be started for infants exposed to HIV at birth, ideally within six hours of delivery.
- HIV testing is recommended for all infants who may be exposed to HIV during pregnancy or childbirth; more frequent testing is recommended for infants at increased likelihood of perinatal transmission, such as infants who are exposed to untreated HIV during childbirth or while breastfeeding.
- When taken as prescribed, HIV medicines can reduce the chances of perinatal transmission of HIV during breastfeeding to less than 1 percent.
Do babies who are exposed to HIV during childbirth receive HIV medicines?
Antiretroviral therapy (ART) is the use of a combination of HIV medicines (antiretrovirals) to treat HIV infection. To prevent perinatal transmission of HIV, all babies exposed to HIV during birth should receive HIV medicines as soon as possible, preferably within six hours of delivery.
HIV medicines given to babies after birth protect against HIV that could have been passed through blood or other body fluids during pregnancy or childbirth.
What HIV medicines are given to babies after birth to prevent perinatal transmission of HIV?
The HIV medicine that a baby receives depends on the likelihood of HIV transmission during pregnancy and childbirth. The likelihood of HIV transmission is typically determined based on the mother’s viral load, especially during the four weeks before delivery. Other factors, such as a new or suspected HIV infection, can also influence the estimated chances of transmission.
Babies with higher chances of HIV exposure during pregnancy and childbirth receive three HIV medicines for up to six weeks after birth. This includes babies born to women who are not virally suppressed four weeks before delivery.
When babies are less likely to be exposed to HIV during pregnancy and childbirth, they may receive short-term HIV prophylaxis using a single HIV medicine. HIV medicines may also change depending on any ongoing risk of HIV transmission while breastfeeding.
A health care provider can help assess the likelihood of HIV transmission during pregnancy and childbirth to choose the appropriate HIV medicines after birth.
If a baby is exposed to HIV at birth, when should they receive an HIV test?
For all babies exposed to HIV before or during birth, HIV testing is recommended at 14 to 21 days of life, at 1 to 2 months, and again at 4 to 6 months. Additional testing at birth and other time points is recommended for babies with a greater chance of perinatal HIV transmission, including those who are exposed to untreated HIV during pregnancy or childbirth.
If testing shows that a baby has HIV, the baby will receive ART based on additional testing (such as drug resistance testing) and other unique considerations that could influence how effective a treatment regimen will be. ART helps people with HIV live long, healthy lives.
What other steps protect babies from perinatal HIV transmission?
In some cases, health care providers may recommend alternatives to breastfeeding to reduce the chances of perinatal HIV transmission.
With consistent use of HIV medicine and an undetectable viral load during pregnancy and throughout breastfeeding, the chances of HIV transmission to a baby who is breastfeeding are less than 1 percent, but not zero. Transmission is much more likely if HIV medicine is not taken as prescribed or if viral load is detectable during pregnancy and throughout breastfeeding.
A health care provider may recommend feeding a baby using properly prepared formula or pasteurized donor human milk from a milk bank to eliminate the chances of perinatal transmission of HIV after birth. Health care providers can help determine the best option(s) for infant feeding after birth.
Additionally, babies should not eat food that was prechewed by a person with HIV. The Centers for Disease Control and Prevention (CDC) has indicated that giving prechewed food to infants can spread HIV or other pathogens, likely through blood in the saliva.
To learn more, read the HIVinfo fact sheets:
This fact sheet is based on information from the following sources:
From the CDC:
From the HIV Clinical Practice Guidelines at Clinicalinfo.HIV.gov:
- Recommendations for the Use of Antiretroviral Drugs During Pregnancy and Interventions to Reduce Perinatal HIV Transmission in the United States:
- Preventing HIV Transmission During Infant Feeding
- Care of Infants With Perinatal Exposure to HIV: Antiretroviral Management of Infants With In Utero, Intrapartum, or Breastfeeding Exposure to HIV
- Care of Infants With Perinatal Exposure to HIV: Diagnosis of HIV Infection in Infants and Children
- Care of Infants With Perinatal Exposure to HIV: Initial Postnatal Management of the Neonate Exposed to HIV
Also see the HIV Source collection of HIV links and resources. For more information regarding infant feeding for people with HIV, see HIVE and the Well Project.