A child cannot be born with Acquired Immunodeficiency Syndrome (AIDS), but they can be infected with the Human Immunodeficiency Virus (HIV) from their mother. This transmission, termed perinatal or vertical transmission, occurs before, during, or shortly after birth. While this was once a significant public health concern, medical advances have drastically reduced the risk of a child acquiring the virus. This outcome is now rare in regions with robust healthcare infrastructure. Understanding the terminology and modern preventive measures is essential to grasp the current reality of this condition.
Clarifying Terminology: HIV Versus AIDS
HIV is the human immunodeficiency virus, a pathogen that attacks and gradually weakens the body’s immune system by destroying CD4 T-cells. A person born with the virus has a viral infection, not the advanced stage of the disease. AIDS is not a virus but a diagnosis representing the most advanced stage of an untreated HIV infection.
AIDS is diagnosed when the immune system is severely compromised, typically defined by a very low CD4 T-cell count or the presence of specific opportunistic infections. Due to effective modern treatment, the syndrome is not inevitable, as not every person with HIV progresses to AIDS.
Understanding Perinatal HIV Transmission
Transmission from a mother living with HIV to her child occurs across three distinct time points, grouped under perinatal transmission.
The first is during pregnancy (in utero transmission), where the virus crosses the placenta to infect the fetus. This can result in the infant being born with the virus already in their system.
The second, and historically most common, time point is intrapartum, occurring during labor and delivery. During vaginal delivery, the infant is exposed to maternal fluids containing the virus. Factors that increase the infant’s exposure to maternal blood, such as prolonged rupture of membranes, raise the risk of transmission.
The third potential route is postpartum, through breastfeeding, as the virus can be present in breast milk. Without intervention, the overall risk of transmission can range from 15% to 45% globally. The mother’s plasma viral load, the amount of HIV in her bloodstream, is the strongest predictor of whether transmission will occur.
Modern Strategies for Preventing Transmission
The comprehensive medical approach known as Prevention of Mother-to-Child Transmission (PMTCT) has dramatically lowered transmission rates to 1% or less in high-resource settings. This success is primarily due to the widespread use of Antiretroviral Therapy (ART) for the pregnant mother. Consistent ART use throughout pregnancy suppresses the mother’s viral load to undetectable levels, nearly eliminating the risk of transmission.
ART is recommended for all pregnant women living with HIV, regardless of their immune cell count, to protect both the mother’s health and the infant. If a woman’s viral load is high (typically over 1,000 copies/mL) near delivery, an elective cesarean section may be recommended. This surgical delivery bypasses exposure to maternal fluids during vaginal birth, offering additional protection.
In resource-rich settings, mothers are advised to exclusively formula-feed to eliminate the risk of postpartum transmission. Where formula feeding is unsafe or infeasible, the mother continues ART while breastfeeding, and the infant also receives prophylactic antiretroviral medication. This combination keeps the risk of transmission very low while allowing breastfeeding.
Diagnosis and Management of Infants with HIV
Management of an infant born to a mother living with HIV begins immediately after birth with prophylactic antiretroviral medication. This post-exposure prophylaxis is given to the newborn, ideally within six hours of delivery, to prevent any virus from establishing a permanent infection. The exact regimen and duration depend on the mother’s viral load status during pregnancy and delivery.
Diagnosing HIV in newborns requires specialized virologic tests, such as nucleic acid amplification tests (NAATs), which detect the virus’s DNA or RNA directly. Standard antibody tests are unreliable because they detect maternal antibodies that crossed the placenta, potentially causing a false positive for up to 18 months. Testing is typically performed multiple times: at birth or within 48 hours, at one to two months, and again at four to six months of age.
If an infant tests positive for HIV, they are immediately started on a combination pediatric ART regimen. Early diagnosis and prompt initiation of treatment are critical to managing the infection and preventing the development of AIDS. With consistent treatment adherence, children born with the virus can lead long, healthy lives with a near-normal life expectancy.