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The Rise and Fall of Perinatal HIV Transmission

April 19, 2023

I am old enough that I have cared for many children with HIV. While some (for example, children with hemophilia or those who were born preterm) contracted HIV through blood transfusions, the vast majority of the HIV infections were through perinatal transmission.

When it was first reported that one could decrease perinatal transmission by treating the pregnant mother and the newborn with antiretroviral medications, it seemed miraculous and impossible. At that time, up to 40% of infants born to HIV-positive mothers became HIV-positive.1

This week in Pediatrics, we are early releasing a Special Article (and accompanying video abstract) entitled, “Achieving Elimination of Perinatal HIV in the United States,” which reports what we once thought to be impossible—the virtual eradication of perinatally transmitted HIV in the US (10.1542/peds.2022-059604). This article, by Dr. Margaret Oampe and colleagues at the CDC (REF), reports that in 2019, the US achieved 2 important milestones that had been articulated as goals by the CDC in 2012:

  • Incidence of <1 case of perinatal HIV per 100,000 live births
  • Perinatal HIV transmission rate of <1%

That is an amazing public health accomplishment! So are we done with pediatric HIV now?

Unfortunately, the answer is no. There continue to be racial and ethnic disparities in the rates of both diagnosis and transmission. In an invited commentary, Dr. Nahida Chakhtoura and Dr. Bill Kapogiannis from NICHD note that the rates of undiagnosed adult HIV infection are higher for Black and Hispanic individuals, and there are structural barriers to testing and care for HIV, and to prenatal care (10.1542/peds.2022-060209).

I would encourage you to read the article, view the video abstract, and read the commentary. While we should feel great about this public health accomplishment, we need to work harder to make sure that every pregnant person comes to prenatal care in time to receive testing for HIV and, if needed, antiretroviral treatment.

Reference:

  1. Mofenson L. Epidemiology and determinants of vertical HIV transmission. Semin Pediatr Infect Dis. 1994;5:252-265
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