HIV and Pregnancy: Navigating Complex Decision Making and Preventing Perinatal Transmission

The objective of this review is to examine the intersection of pregnancy and HIV, focusing on birthing person and fetal health outcomes, prevention of perinatal HIV transmission, and the latest advancements in treatment and care in the United States. It highlights current guidelines, challenges in management, and future directions for improving outcomes.

HIV treatment guidelines continue to highlight key principles for the choice of antiretroviral therapy in pregnancy, challenges, and strategies for adherence support. Guidelines have been updated to reflect patient-centered counseling to support shared decision making about infant feeding. Counseling should begin prior to pregnancy, and be reviewed throughout pregnancy, again at delivery, and throughout the periods when breast/chestfeeding occurs. ART use during pregnancy has significantly reduced perinatal HIV transmission. Ongoing research and collaboration are vital to addressing remaining challenges. Prioritizing maternal and infant health ensures that ART not only prevents transmission but also improves future health for families affected by HIV.