HIV-1 seroconversion during pregnancy resulting in vertical transmission

Area of Science:

• Infectious Diseases
• Public Health
• Obstetrics & Gynecology

Background:

• Antenatal Human Immunodeficiency Virus (HIV) testing uptake in England and Scotland rose to 92% by 2004 following an opt-out policy.
• Late-pregnancy HIV seroconversion poses a risk for mother-to-child transmission (MCT) if not detected between initial booking and delivery.

Purpose of the Study:

• To highlight the risk of missed HIV seroconversions during pregnancy.
• To evaluate the effectiveness of current antenatal HIV testing strategies.
• To recommend further testing protocols for at-risk pregnant individuals.

Main Methods:

• Case reports of two women experiencing late-pregnancy HIV infection.
• Review of antenatal HIV testing policies and uptake rates.
• Analysis of mother-to-child transmission risks and outcomes.

Main Results:

• A 32-year-old woman with late-term symptomatic HIV infection transmitted the virus to her infant despite interventions.
• Another case involved late-pregnancy HIV seroconversion detected after a partner's AIDS diagnosis, despite high hospital testing rates.
• Current opt-out policies may not capture all late-pregnancy seroconversions.

Conclusions:

• Further maternal HIV testing later in pregnancy is crucial, particularly in diverse, high-risk areas like London.
• Enhanced strategies are needed to prevent perinatal HIV transmission.
• National data on pregnancy-associated HIV seroconversion rates are lacking and needed.