The main goal is to reduce the mother’s viral load (the concentration of HIV in the body) to undetectable levels using antiretroviral drugs. By achieving this, the risk of transmission can be reduced to near-negligible levels.
Antenatal Prevention
The antenatal (prenatal) period is the time between conception and the onset of labor. This is time when antiretroviral therapy is prescribed to the mother to achieve complete viral suppression. By sustaining an undetectable viral load, the chance of HIV transmission is almost entirely eliminated.
DHHS Recommendations
The choice of antiretroviral drug varies by whether a mother is newly treated or is currently on treatment. Recommendations are issued by a panel of experts in the Department of Health and Human Services (DHHS), who have assigned a preferred status to certain combination therapies.
The DHHS lists 14 preferred options for pregnant persons newly treated for HIV. Some require anywhere from one to four pills taken either on a once-daily or twice-daily schedule.
None of the options are inherently “better” than the others, although some conditions may either exclude certain drugs or make them a more attractive option.
According to the Centers for Disease Control and Prevention (CDC), around 2,000 people with HIV in the United States remain undiagnosed during pregnancy each year. Others receive little to no antenatal care or only begin HIV treatment late in the third trimester.
For those who are untreated or unable to achieve an undetectable viral load, more aggressive last-minute interventions may be needed. This may include a continuous intravenous (IV) infusion of the antiretroviral drug AZT (zidovudine) to quickly bring down the viral load prior to delivery.
DHHS Recommendations
The DHHS recommendations regarding intrapartum prevention vary by the treatment status of the mother at the time of delivery. According to the guidelines:
People who are currently on antiretroviral therapy should continue taking their medications for as long as possible. Upon arrival at the hospital, a viral load test will be performed to decide if additional interventions are needed. People who are not on treatment or of unknown status will be given an HIV test to confirm their status. Women who test positive will also undergo viral load testing.
Based on the findings, the DHHS recommends the following preventive interventions:
The choice of prophylactic medication varies by the treatment and viral load status of the mother, as well as whether the baby is confirmed to have HIV.
Traditional antibody tests are not used in newborns because they will often detect the mother’s antibodies (which will disappear in time) rather than the baby’s.
DHHS Recommendations
Depending on the risk category of the mother, postnatal interventions for the baby may involve either a short course of AZT (zidovudine) syrup on its own or a longer course of treatment with one of the following therapies:
AZT (zidovudine) + Epivir (lamivudine) + Viramune (nevirapine) AZT (zidovudine) + Epivir (lamivudine) + Isentress (raltegravir)
The doses of the drugs are calculated based on the child’s weight in kilograms (kg).
The same may not be true in developing countries where the lack of access to clean water and affordable baby formula is often lacking. In countries like these, the benefits of breastfeeding outweigh the risks.
A Word From Verywell
The routine testing of HIV in pregnant women In the United States has reduced the incidence of mother-to-child transmission to less than one of every 100,000 births.
As effective as these interventions are, there is evidence that treating a mother before she becomes pregnant may be even more effective. A 2015 study from France involving 8,075 mothers with HIV concluded that starting antiretroviral therapy before conception effectively reduced the risk of mother-to-child transmission to zero.
If you are planning to get pregnant and don’t know your status, speak to your healthcare provider about getting an HIV test. The U.S. Preventive Services Task Force currently recommends HIV testing for all Americans 15 to 65 as part of a routine practitioner visit.
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