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Congenital HIV: Prevention of Maternal to Child Transmission

Lynch, Natalie Gordon, MSN, NNP-BC; Johnson, Alexandra Kesler, MSN, NNP-BC

Section Editor(s): Newberry, Desi M.

doi: 10.1097/ANC.0000000000000559
Special Series: Congenital Infections

Background: Human immunodeficiency virus (HIV) is caused by a cytopathic lentivirus. HIV without adequate treatment during pregnancy can result in maternal to child transmission (MCT) of the virus. Sequelae can include severe lifelong morbidities, shorter life expectancies, and high mortality rates without antiretroviral therapy.

Purpose: To discuss epidemiological trends, pathophysiology, and clinical care guidelines including those for diagnosis, treatment, and management of MCT of HIV in the United States. To emphasize the importance of prompt identification, prophylaxis, and treatment of at-risk infants.

Methods: PubMed, CINAHL, MEDLINE, and Google Scholar were used to search key words—maternal to child transmission, HIV, HIV in pregnancy, and neonatal HIV—for articles that were relevant and current. The World Health Organization, Centers for Disease Control and Prevention, and UNICEF were also utilized for up-to-date information on the topic.

Findings: Timely identification, intervention, and treatment are necessary to prevent MCT of HIV. Membrane rupture duration is not associated with higher transmission rates with adequate viral suppression.

Implications for Practice: An evidence-based maternal/neonatal collaborative approach to care for the prevention and management of MCT of HIV including adherence to combined antiretroviral therapy (cART) should be emphasized. Early testing, prophylaxis, and treatment for neonates at risk, as well as education on current clinical care guidelines for caregivers.

Implications for Research: Pregnancy complications of cART. MCT rates in conjunction with birthing practices and restrictions among women living with HIV with low to undetectable viral loads.

Coastal Carolina Neonatology, and Neonatal Intensive Care Unit, New Hanover Regional Medical Center, Wilmington, North Carolina (Ms Lynch); and Intensive Care Nursery, Duke University Hospital, Durham, North Carolina (Ms Johnson).

Correspondence: Natalie Gordon Lynch, MSN, NNP-BC, 2212 South 17th St, Wilmington, NC 28401 (natalie.lynch@ccneo.net).

The authors declare no conflicts of interest.

© 2018 by The National Association of Neonatal Nurses