HIV infection in people who are pregnant remains a significant public health challenge. For all individuals with HIV, antiretroviral therapy (ART) should be initiated at HIV diagnosis and continued indefinitely. In 2021, approximately 19.7 million of the 38.4 million people worldwide living with HIV were females older than 15 years, and approximately 79% were of childbearing age. Each year, about 1.3 million people with HIV worldwide (and about 5000 in the US) give birth.
For pregnant people with HIV, ART is essential for preserving maternal health and preventing perinatal and sexual HIV transmission. Without ART, approximately 15% to 40% of pregnant or breastfeeding people with HIV will have a child who acquires HIV. However, the risk of perinatal and postpartum transmission is less than 2% if ART is used from early in pregnancy with sustained viral suppression (defined as confirmed HIV RNA level below the lower limits of detection of an ultrasensitive assay). Currently, approximately 81% of pregnant people with HIV are receiving ART worldwide. Increased ART use has resulted in a 50% reduction in new perinatal infections globally, from approximately 320 000 in 2010 to 160 000 in 2021. Approximately 48% of the 160 000 new perinatal infections in 2021 occurred in infants born to people who did not receive ART during pregnancy, often because they did not know their HIV status; 22% in infants born to people who first acquired HIV during pregnancy or breastfeeding; 22% in infants born to people who stopped treatment during pregnancy or breastfeeding; and 8% in infants born to pregnant people taking ART without adequate viral suppression.
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Corresponding Author: Lynne M. Mofenson, MD, Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), 15117 Timberlake Dr, Silver Spring, MD 20905 (email@example.com).
Published Online: April 3, 2023. doi:10.1001/jama.2023.5076
Conflict of Interest Disclosures: Dr Mofenson serves as a paid consultant to the World Health Organization on issues related to antiretroviral drugs in pregnancy, and her employer has received funding from ViiV for a pilot birth outcomes surveillance project in Eswatini. No other disclosures were reported.
Funding/Support: Overall support for this work was provided by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health (NIH) under award 1K23HD104517 (Dr Eke) and the National Institute of Allergy and Infectious Diseases under award 5K24AI131928 (Dr Lockman).
Role of the Funder/Sponsor: The funders had no role in the preparation, review, or approval of the manuscript or decision to submit the manuscript for publication.
Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
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