Predicting in utero HIV infection in newborns

HIV symptoms in newborns and insufficient prenatal care, limited antiretroviral therapy, and high viral load in mothers increased likelihood of in utero infection.

Successful programmes are in place worldwide to prevent mother-to-infant HIV transmission that occurs around the time of birth, but some infants are infected prior to delivery, typically resulting in early disease progression. Universal testing of infants in areas with high maternal infection rates identifies infected infants after the first month of life, but for infants infected in utero, earlier detection would allow for earlier antiretroviral therapy (ART).

To determine maternal and infant characteristics associated with high risk for in utero HIV infection, investigators studied HIV-infected mothers and 1691 infants who received HIV polymerase chain reaction (PCR) testing at birth at a tertiary hospital in Pretoria, South Africa, where the rate of HIV in women giving birth was 22%.

Infants had excess risks for positive HIV PCR results if they were symptomatic at birth (such as with growth restriction, anaemia, or pneumonia) or if their mothers had <3 prenatal care visits, <4 weeks of ART, or viral loads ≥1000 copies/mL.