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Perinatal HIV transmission in the U.S. can approach rates of <1% if appropriate interventions are offered to both pregnant individuals and their neonates.
However, a recently published case series evaluating hospitals in Maryland noted that there were 6 new cases of perinatal HIV transmission in 2022, compared with nationwide decreases and zero cases in the state of MD in 2021. Transmission was believed to be related to several issues: delayed entry to prenatal care, HIV diagnosis occurring in pregnancy (as opposed to pre-conception), adherence in the setting of hardships such as substance use, and delays in anti-retroviral therapy (ART) initiation during pregnancy.
How can we work to lower perinatal HIV transmission? Opportunities include the use of pre-exposure prophylaxis (PrEP), routine HIV testing in individuals of child-bearing age (especially if at high-risk of HIV acquisition), and rapid initiation of ART in pregnant individuals. As emergency physicians and providers, we are at the front line of assessing for these barriers and getting patients the resources they need to minimize perinatal transmission.
References
Griffith DC, Grant M, Koay WLA, Rakhmanina N, Powell AM, Agwu A. Increase in Cases of Perinatal HIV Transmission in Maryland in 2022. Pediatrics. 2024;154(5):e2023065371. doi:10.1542/peds.2023-065371