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Review
. 2025 Jun 7;22(1):36.
doi: 10.1007/s11904-025-00745-0.

HIV and Pregnancy: Navigating Complex Decision Making and Preventing Perinatal Transmission

William R Short  1 , Elizabeth D Lowenthal  2   3   4 , Florence Momplaisir  5   6 , Kathleen M Powis  7   8 , Rachel K Scott  9 , Lynn M Yee  10 , Emily S Miller  11 , Lynne M Mofenson  12
Affiliations
Review

HIV and Pregnancy: Navigating Complex Decision Making and Preventing Perinatal Transmission

William R Short et al. Curr HIV/AIDS Rep. .

Abstract

Purpose of review: The objective of this review is to examine the intersection of pregnancy and HIV, focusing on birthing person and fetal health outcomes, prevention of perinatal HIV transmission, and the latest advancements in treatment and care in the United States. It highlights current guidelines, challenges in management, and future directions for improving outcomes.

Recent findings: HIV treatment guidelines continue to highlight key principles for the choice of antiretroviral therapy in pregnancy, challenges, and strategies for adherence support. Guidelines have been updated to reflect patient-centered counseling to support shared decision making about infant feeding. Counseling should begin prior to pregnancy, and be reviewed throughout pregnancy, again at delivery, and throughout the periods when breast/chestfeeding occurs. ART use during pregnancy has significantly reduced perinatal HIV transmission. Ongoing research and collaboration are vital to addressing remaining challenges. Prioritizing maternal and infant health ensures that ART not only prevents transmission but also improves future health for families affected by HIV.

Keywords: Antiretroviral therapy; HIV; Pregnancy; Teratogenicity.

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Conflict of interest statement

Declarations. Human and Animal Rights and Informed Consent: The article does not contain any studies with human or animal subjects performed by any of the authors. Conflict of interest: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Rate of Perinatal HIV transmission over time. Reproduced with permission from Keeshin S and Ciaranello A. Eckel RH. HIV and pregnancy: treatment, infant feeding, and prevention. NEJM group infectious diseases update October 2024, pp. 15–19, Copyright 2024 Massachusetts Medical Society
Fig. 2
Fig. 2
Algorithm for antiretroviral management of infants with In Utero or Intrapartum HIV exposure by risk of HIV transmission. Source: Panel on antiretroviral therapy and medical management of children living with HIV. Guidelines for the use of antiretroviral agents in pediatric Hiv Infection. Department of Health and Human Services. Available at https://clinicalinfo.hiv.gov/en/guidelines/pediatric-arv. Accessed April 10, 2025
See this image and copyright information in PMC

References

    1. Lampe MA, Nesheim SR, Oladapo KL, et al. Achieving elimination of perinatal HIV in the United States. Pediatrics. 2023;151(5). https://pubmed.ncbi.nlm.nih.gov/37070379. Accessed 14 Dec 2024. - PMC - PubMed
    1. Machtinger EL, Wilson TC, Haberer JE, Weiss DS. Psychological trauma and PTSD in HIV-positive women: a meta-analysis. AIDS Behav. 2012;16(8):2091–100. - PubMed
    1. Bonacquisti A, Geller PA, Aaron E. Rates and predictors of prenatal depression in women living with and without HIV. AIDS Care. 2014;26(1):100–6. - PubMed
    1. Cohn SE, Umbleja T, Mrus J, Bardeguez AD, Andersen JW, Chesney MA. Prior illicit drug use and missed prenatal vitamins predict nonadherence to antiretroviral therapy in pregnancy: adherence analysis A5084. AIDS Patient Care STDS. 2008;22(1):29–40. - PubMed
    1. Yee LM, Kacanek D, Brightwell C, et al. Marijuana, Opioid, and Alcohol Use Among Pregnant and Postpartum Individuals Living With HIV in the US. JAMA Netw Open. 2021;4(12):e2137162. 10.1001/jamanetworkopen.2021.37162. - PMC - PubMed

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