Each year in the United States, approximately 6000 pregnant women infected with HIV-1 give birth. Cost-saving preventive strategies have reduced the risk of mother-to-child transmission of HIV-1 to approximately 1% to 2%. These strategies include universal HIV-1 antibody testing of pregnant women, and for those infected with HIV-1, antiretroviral (ARV) prophylaxis for mothers and newborns, elective cesarean deliveries, and avoiding breastfeeding. A clinical report detailing the evaluation and management of neonatal HIV-1 infection was published in the January 2009 issue of Pediatrics.1

All HIV-1-exposed infants should receive zidovudine for 6 weeks. At the time of discharge, the family should be given a quantity of drug sufficient to complete the 6-week course. It is not adequate to provide a prescription and recommendations to purchase zidovudine; the family should leave the hospital with drugs in hand.

For newborn infants whose mother's HIV-1 serostatus is unknown, rapid HIV-1 antibody testing on the mother and the infant should be performed to allow ARV prophylaxis to be started as soon after birth as possible and at least within 12 hours of life. ARV prophylaxis should be started solely on the basis of a positive rapid antibody test result, without waiting for results of confirmatory HIV-1 testing. Breastfeeding should not take place until confirmatory test results are known. The longer the delay in beginning treatment, the less likely it is that HIV will be prevented. Starting treatment at 24 to 36 hours is not effective in preventing infection.

Postnatal transmission of HIV-1 through ingestion of human milk from a mother with HIV-1 infection is well documented. In the United States, where the risk of infant mortality from infectious diseases and malnutrition is low and effective alternative sources of feeding are readily available, women with HIV-1 infection, even if receiving ARV therapy, should be counseled not to breastfeed their infants. Counseling should take place in a culturally sensitive manner.

The most common serious opportunistic infection in HIV-1-infected infants and children is Pneumocystis carinii pneumonia. It occurs most often in HIV-1-infected infants during the first year of life, with cases peaking at 3 to 6 months of age. Chemoprophylaxis is highly effective in its prevention and should be initiated in HIV-1-infected infants.

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