Primary human immunodeficiency virus infection during pregnancy detected by repeat testing

Area of Science:

• Infectious Diseases
• Maternal Health
• Public Health

Background:

• Newly acquired human immunodeficiency virus (HIV) during pregnancy poses risks for mother-to-child transmission.
• Routine prenatal screening may miss primary HIV infections acquired late in gestation.

Purpose of the Study:

• To characterize pregnant women with newly acquired HIV infection identified through repeat testing.
• To assess the prevalence of primary HIV infection during pregnancy within a study cohort.

Main Methods:

• The Mother-Infant Rapid Intervention at Delivery (MIRIAD) study encouraged repeat HIV testing in pregnant women across 6 US cities.
• Primary infections were identified based on estimated seroconversion timing and clinical data.

Main Results:

• Of 54 HIV-infected women, 6 (11%) had primary HIV infection during pregnancy, with seroconversion around 22 weeks gestation.
• Three of four mother-infant pairs with primary infection received antiretroviral prophylaxis.
• One infant born to a mother with primary infection acquired HIV perinatally.

Conclusions:

• Repeat HIV testing during pregnancy is crucial for identifying primary infections.
• Early detection facilitates timely antiretroviral prophylaxis, reducing perinatal HIV transmission.
• This strategy is particularly important in areas with high HIV prevalence.