Since the beginning of the HIV/AIDS epidemic, approximately 15,000 children in the United States have been infected with HIV. And, 3,000 children have died. Approximately 90 percent of those children were infected with the virus during pregnancy or birth.
HIV transmission from mother to child during pregnancy, labor, delivery or breastfeeding is called perinatal transmission. Perinatal HIV transmission is the most common way that children are infected with HIV and is currently the source of nearly all AIDS cases in children in the United States.
In the early 1990s, research showed that certain HIV drugs that were given to HIV infected pregnant women and their newborns reduced the risk for perinatal transmission. Since that time, treatment for HIV positive pregnant women has resulted in a dramatic decline in the number of children infected with HIV during pregnancy, labor, deliver or breastfeeding.
Notwithstanding, approximately 100–200 infants in the United States are still infected with HIV annually. This most often occurs when their mothers were not tested early enough in pregnancy or did not receive preventative treatment.
Implementation of recommendations for universal prenatal HIV testing, certain HIV drugs during and after pregnancy, and elective cesarean delivery have resulted in a 95 percent decrease in the number of perinatal HIV/AIDS cases in the United States over the past twenty years. Several studies have shown that cesarean delivery performed before onset of labor and membrane rupture can reduce HIV transmission to infants in mothers who are not receiving HIV medication during pregnancy.
Doctors, of course, must weigh the uncertain benefit of preventing perinatal HIV transmission via early cesarean by the potential risks of prematurity and operative delivery in such women, especially given the fact that the risk for perinatal HIV transmission from an HIV-infected mother to infant is currently less than 2 percent.
The reduction of perinatal HIV transmission in the United States is in great contrast with the perinatal transmission rates in poorer regions, such as in sub-Saharan Africa.