Mother-to-Child Transmission of HIV at a Stalemate

HIV viral suppression at the time of birth much worse than expected.

Despite many gains in the fight against HIV, more work is needed to save the next generation from infection.

Recent research reveals that the occurrence of HIV-infected women passing on the disease to their newborn babies is not improving, despite opportunities for HIV-positive pregnant women to prevent passing the disease to their child and maintain a long-term pattern of maintenance care after giving birth.

Studies led by a team of researchers from Drexel University and the Philadelphia Department of Public Health (PDPH) are the first to describe the HIV care continuum postpartum and to use population-based data to evaluate viral suppression rates of HIV-infected pregnant women at delivery. The studies evaluated the pregnancies of HIV-infected women who gave birth between 2005 and 2011, and 2005 and 2013.

According to the research, the engagement of women in prenatal care was poorer than expected among those studied. Only about one-third of women receive adequate prenatal care, one-third received an intermediate level of care, and one-third receive prenatal care that was inadequate.

Only about half of the women observed had their HIV viral levels suppressed at the time of birth, an outcome that physicians and public health officials target to prevent transmission of the infection.

“We had expected the viral suppression rate to be much better at delivery because there is a known infrastructure to prevent mother-to-child transmission of HIV,” said Florence Momplaisir, MD, MSHP, an assistant professor at the Drexel University College of Medicine who was lead author of the PLOS ONE study and senior author of the Clinical Infectious Diseases study.

In the study published in Clinical Infectious Diseases, researchers examined HIV care during pregnancy and for 2 years after delivery. The study found that a resounding 92% of women received antiretroviral therapy or an HIV lab tests during the time of pregnancy, but only 38% of women engaged in care within 90 days after giving birth.

Another finding of the study indicated that women were more likely to stick with care up to 2 years after delivery when they received it soon after giving birth.

“Women engaged in care within 90 days of delivery were 11 times as likely to be retained in care and twice as likely to be virally suppressed at a year postpartum,” Dr. Momplaisir said. “This suggests there is a window of opportunity after delivery to establish lasting care.”

The main message scientists want HIV-infected women to take away from this study is to seek care during this crucial window of opportunity and prior to becoming pregnant in order to prevent mother-to-child transmission of the disease. Getting the care patients need is the first step in disease prevention.