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HIV and Women

Preventing Mother-to-Child Transmission of HIV After Birth

(Last updated 10/1/2013; last reviewed 10/1/2013)

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Key Points

  • Babies born to women with HIV should receive zidovudine (brand name: Retrovir) for 6 weeks after birth to prevent mother-to-child transmission of HIV. The HIV medicine protects the babies from infection with any HIV that passed from mother to child during childbirth.
  • HIV testing for babies born to women with HIV is recommended at 14 to 21 days after birth, at 1 to 2 months, and again at 4 to 6 months. Testing should be done using a test that looks directly for HIV in the blood (called a virologic HIV test).
  • Results on two virologic tests must be negative to be certain that a baby is not infected with HIV. The first negative result must be from a test done when a baby is 1 month or older and the second result from a test done when a baby is 4 months or older. Results on two HIV virologic tests must be positive to know for certain that a baby is infected with HIV
  • If test results show that a baby has HIV, the baby will be switched from zidovudine to a combination of HIV medicines. HIV medicines help children infected with HIV live healthier lives.  
  • Because HIV can spread in breast milk, HIV-infected women in the United States should not breastfeed their babies. In the United States, infant formula is a safe and healthy alternative to breast milk.

How many babies in the United States are born with HIV?

Fewer than 200 babies with HIV are born each year in the United States.

The risk of mother-to-child transmission of HIV is low when:

  • Women with HIV receive HIV medicine during pregnancy and childbirth and, in certain situations, have a scheduled cesarean delivery (also called a C-section).
  • Babies born to women with HIV receive HIV medicines for 6 weeks after birth and are not breastfed. (HIV can pass from mother to child in breast milk.)

How soon after birth do babies born to women with HIV begin to receive HIV medicines to prevent mother-to-child transmission of HIV?

Within 6 to 12 hours after birth, all babies born to women with HIV should receive an HIV medicine called zidovudine (brand name: Retrovir). The babies receive zidovudine for 6 weeks. In certain situations, a baby may receive other HIV medicines in addition to zidovudine. The HIV medicine protects the babies from infection with any HIV that passed from mother to child during childbirth.

Babies born to women with HIV receive a medication called sulfamethoxazole/trimethoprim (brand name: Bactrim) after they have finished the 6-week course of zidovudine. Bactrim helps prevent Pneumocystis jiroveci pneumonia (PCP), which is a type of pneumonia that can develop in people with HIV. If HIV testing shows that a baby is not infected with HIV, there is no need for the baby to continue getting Bactrim and the medicine is stopped. 

How soon after birth are babies born to women with HIV tested for HIV?

HIV testing is recommended at 14 to 21 days after birth, at 1 to 2 months, and again at 4 to 6 months. Testing should be done using an HIV test that looks directly for HIV in the blood (called a virologic HIV test). (In adults, the most commonly used HIV test is the HIV antibody test, which looks for HIV antibodies in the blood.) Test results from at least two HIV virologic tests are needed to determine a baby’s HIV status (HIV negative or HIV positive).

  • HIV-negative status/not infected with HIV
    To know for certain that a baby is not infected with HIV, results on two virologic tests must be negative. The first negative result must be from a test done when a baby is 1 month or older, and the second result from a test done when a baby is 4 months or older.
  • HIV-positive status/infected with HIV
    To know for certain that a baby is infected with HIV, results on two HIV virologic tests must be positive.

Fortunately, few babies in the United States are born with HIV because most HIV-infected women take HIV medicines during their pregnancies. But for babies who are born with the virus, treatment with a combination of HIV medicines (called antiretroviral therapy or ART) should begin soon after HIV is diagnosed. (After diagnosis, babies already receiving zidovudine are switched to ART). ART helps people with HIV live longer, healthier lives.  

What other steps are used to protect babies from HIV?

Because HIV can spread in breast milk, women with HIV who live in the United States should not breastfeed their babies. In the United States, infant formula is a safe and healthy alternative to breast milk. 

There is evidence that HIV can spread in food that was previously chewed by a person infected with HIV. To be safe, babies should not be fed pre-chewed food.

Do women with HIV continue to take HIV medicines after childbirth?

Treatment with HIV medicines is currently recommended for everyone infected with HIV. The recommendation is strongest for those with CD4 counts less than 350 cells/mm3; those who have symptoms of HIV disease; high levels of HIV in their blood (HIV viral load); or certain conditions, such as AIDS or certain HIV-related illnesses or conditions. Women who took HIV medicines during pregnancy and childbirth only to prevent mother-to-child transmission of HIV may not need to take HIV medicines after they give birth. Other women may need to continue taking HIV medicines to protect their own health. 

A woman’s decision to continue or stop taking HIV medicines after childbirth should always be made in consultation with a health care provider. Her decision will depend on several factors, including:

  • The latest recommendations on the use of HIV medicines
  • Her CD4 count and viral load levels
  • Any issues that may make it hard for her to take HIV medicines exactly as directed
  • Whether her partner is infected with HIV
  • Her personal preferences and those of her health care provider

This fact sheet is based on information from the following sources: