Human immunodeficiency virus (HIV) is a virus that attacks the body’s immune system. If untreated, HIV can lead to the acquired immunodeficiency syndrome (AIDS). HIV spreads through contact with certain body fluids or blood from an HIV-infected person.

When a pregnant mother has an HIV infection or AIDS, the virus can infect the baby during pregnancy, delivery, or while breastfeeding. HIV is passed on from mother to infant most often during delivery (perinatal transmission). Treatment of a mother with HIV infection during pregnancy with antiviral medications can reduce a baby’s chance of getting the infection.

The best way to prevent babies from HIV infection is to screen all pregnant women for HIV infection. Pregnant women who are infected with HIV then receive antiviral medications to reduce the amount of virus. While around 5,000 babies are born each year in the United States to HIV-infected mothers, less than 100 babies are born with an HIV infection each year due to the use of screening and antiviral therapy.

Babies infected with HIV before birth will not have any health problems right away, but often develop signs and symptoms a little later in life.

It is estimated that fewer than 100 babies are born with this condition each year in the United States.

Key Points

• HIV can pass from a mother with HIV to her child during pregnancy, childbirth, or breastfeeding, called perinatal transmission of HIV. In the United States, this is the most common way children under 13 years of age get HIV. Perinatal transmission of HIV is also called mother-to-child transmission of HIV.
• Most youth who acquire HIV during adolescence get it through sexual transmission.
• Several factors affect HIV treatment in children and adolescents, including a child’s growth and development. For example, because children grow at different rates, dosing of an HIV medicine may depend on a child’s weight rather than their age.
• Medication adherence can be difficult for children and adolescents. For example, adolescents may skip HIV medicine doses to hide their HIV-positive status from others.

Does HIV affect children and adolescents?

Yes, children and adolescents are among the people living with HIV in the United States.

• According to the Centers for Disease Control and Prevention (CDC), 87 cases of HIV in children younger than 13 years of age were diagnosed in the United States in 2018.
• CDC reports that youth 13 to 24 years of age accounted for 21% of all new HIV diagnoses in the United States and dependent areas in 2018.

How do most children get HIV?

HIV can pass from a mother with HIV to her child during pregnancy, childbirth, or breastfeeding, called perinatal transmission of HIV. In the United States, this is the most common way children under 13 years of age get HIV. Perinatal transmission of HIV is also called mother-to-child transmission of HIV.

The use of HIV medicines and other strategies have helped to lower the rate of perinatal transmission of HIV to 1% or less in the United States and Europe.

How do adolescents get HIV?

Some adolescents, 13 to 19 years of age, with HIV in the United States acquired the virus as infants through perinatal transmission. But most youth who acquire HIV during adolescence get it through sexual transmission. Many adolescents with HIV do not know they are HIV positive.

What factors increase the risk of HIV in adolescents?

Several factors make it challenging to prevent adolescents from getting HIV. Many adolescents lack basic information about HIV and how to protect themselves from HIV.

The following are some factors that put adolescents at risk of HIV:

• Low rates of condom use. Always using a condom correctly during sex reduces the risk of HIV and some other sexually transmitted diseases (STDs).
• High rates of STDs among youth. An STD increases the risk of getting or spreading HIV.
• Alcohol or drug use. Adolescents under the influence of alcohol or drugs may engage in risky behaviors, such as having sex without a condom.

What factors affect HIV treatment in children and adolescents?

Treatment with HIV medicines (called antiretroviral therapy or ART) is recommended for everyone with HIV, including children and adolescents. HIV medicines help people with HIV live longer, healthier lives and reduce the risk of HIV transmission.

Several factors affect HIV treatment in children and adolescents, including a child’s growth and development. For example, because children grow at different rates, dosing of an HIV medicine may depend on a child’s weight rather than their age. Children who are too young to swallow a pill may use HIV medicines that come in liquid form.

Issues that make it difficult to take HIV medicines every day and exactly as prescribed (called medication adherence) can affect HIV treatment in children and adolescents. Effective HIV treatment depends on good medication adherence.

Why can medication adherence be difficult for children and adolescents?

Several factors can make medication adherence difficult for children and adolescents with HIV. For example, a child may refuse to take an HIV medicine because it tastes unpleasant.

Negative beliefs and attitudes about HIV (called stigma) can make adherence especially difficult for adolescents living with HIV. They may skip medicine doses to hide their HIV-positive status from others.

The following factors can also affect medication adherence in children and adolescents:

• A busy schedule that makes it hard to take HIV medicines on time every day
• Side effects from HIV medicines
• Issues within a family, such as physical or mental illness, an unstable housing situation, or alcohol or drug abuse
• Lack of health insurance to cover the cost of HIV medicines
• A child’s age and developmental stage.

Pregnant women can pass HIV to their unborn or recently born baby. A mother with HIV or AIDS can pass on HIV to her baby during pregnancy, childbirth, or while breastfeeding.

The risk of transmission from mother to baby is highest during labor and delivery, followed by breastfeeding, and lowest during pregnancy itself.

HIV is not inherited through a person’s genes. The risk for HIV infection in siblings will depend on how well the mother’s HIV infection is controlled during those pregnancies.

There are a number of ways you can reduce your risk of your baby being infected with HIV:

• Take antiretroviral therapy (ART) during and after pregnancy to prevent the virus from making copies of itself
• Talk to your health care provider about whether a cesarean delivery (C-section) would be safer
• Feed your baby with formula or donor breastmilk instead of breastfeeding
• Do not pre-chew your baby’s food

Babies with HIV will have no health problems at birth but will develop signs and symptoms, usually within 4 to 18 months, occasionally a few years later.

Signs of the condition include the following:

• Poor growth and weight gain
• Diarrhea
• Creamy white dots in the mouth or throat that do not get better (thrush)
• High number of infections or infections caused by germs that do not affect healthy babies
• Large lymph nodes
• Multiple ear infections
• Rash
• Large liver or spleen (hepatomegaly or splenomegaly)
• Developmental delay

The Centers for Disease Control and Prevention (CDC) recommends that all pregnant women receive screening for HIV infection. HIV-infected women can receive antiviral therapy to prevent them from passing HIV to the baby. A state may offer an additional test for HIV exposure through newborn screening. Newborn screening for HIV requires collecting a small amount of blood from your baby’s heel.

Screening measures whether your baby’s blood contains HIV antibodies. Antibodies are special proteins the body’s immune system makes in response to an infection. Pregnant women pass antibodies on to their babies.

What Happens After an Out-of-Range Screening Result?

If your baby’s HIV antibody screen is positive, your baby’s health care provider will contact you. Together, you will discuss next steps and follow-up plans.

A positive HIV screening result indicates that your baby was possibly exposed to HIV during your pregnancy or delivery. It does not mean that your baby is infected or will have or develop health problems. It does mean that your baby needs more follow-up testing.

Your baby may need the following tests after a positive HIV screening result:

• Blood tests (usually repeated every couple of months for the first year of life)

You should complete any recommended follow-up testing as soon as possible. Babies with this condition may develop health problems if they are not diagnosed and treated.

False-positive screening results for HIV can and do happen.

Newborn screening helps babies lead healthier lives. If your baby has a positive HIV result, follow up with your health care provider quickly. It is important to follow their instructions. Your baby may need to get treatment, even if they are not showing signs or symptoms. In some cases, your baby’s health care provider may decide it is best to watch (monitor) your baby to decide next steps. Careful monitoring and early treatment will help your baby stay as healthy as possible.

Babies born to HIV-infected mothers will receive a short course of antiviral medicine to help prevent infection (prophylaxis). Babies with a HIV infection will get treatment right away with additional antiviral medicines. It is important to talk to your health care provider about which treatment(s) are best for your baby. The goal of treatment is to try to prevent some of the health problems this condition causes.

Treatment options can include the following:

• HIV medicines (zidovudine and others)
• Antibiotics to help prevent infections
• Modification of routine vaccinations if infant is severely immunocompromised

If you are pregnant or planning to get pregnant, get tested for HIV as soon as possible. If you have HIV, the sooner you start treatment the better—for your health and your baby’s health, and to prevent transmitting HIV to your sex partner. If you don’t have HIV, but your partner does, ask your health care provider about medicine to prevent HIV, called pre-exposure prophylaxis (PrEP). You can also talk to your health care provider about timing sex without a condom to coincide with ovulation to reduce the chances of HIV transmission and increase the likelihood of getting pregnant.

What You Can Do If You Are Pregnant and Have HIV

*Viral suppression is defined as having less than 200 copies of HIV per milliliter of blood. An undetectable viral load means having a viral load so low that a test can’t detect it. The benefits of having an undetectable viral load also apply to people who stay virally suppressed.

People who are pregnant or trying to get pregnant should encourage their partners to also get tested for HIV. If either partner has HIV, that partner should take HIV treatment as prescribed to stay healthy and prevent transmission.

For babies with HIV, starting treatment early is important because the virus can progress quickly in children. Providing HIV treatment early can help children with HIV live longer, healthier lives.