Perinatal transmission is the most common source of HIV infection among infants and children in the United States, accounting for >90% of children with acquired immunodeficiency syndrome (AIDS) <13 years. In the United States, the number of infants born with HIV in 2001 was between 280 and 370, compared with approximately 1,000 to 2,000 neonates with HIV born in 1991. During the same period, the number of mothers with HIV in the United States also increased. Much of the success of the declining transmission rates, despite rising number of pregnant women with HIV, is the result of increased HIV screening of pregnant women and the use of antiretroviral drugs for both mother and baby.

The American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists issued a joint statement supporting universal testing with patient notification as a routine component of prenatal care. Optimally, results of HIV should be known prior to labor and delivery to facilitate antepartum and intrapartum treatment. If the mother’s HIV status was not determined during pregnancy, the AAP encourages pediatricians to discuss with the mother benefits of early identification of HIV and recommends testing at that time.

In 1994, the results of Pediatric AIDS Clinical Trials Group (PACTG) Protocol 076 documented that a three-part zidovudine (ZDV) chemoprophylaxis regimen could reduce the risk of perinatal HIV transmission by approximately two-thirds. The regimen includes oral ZDV initiated at 14 to
34 weeks’ gestation and continued throughout pregnancy, followed by intravenous ZDV during labor and oral administration of ZDV to the infant for 6 weeks after delivery. Oral administration of ZDV to the newborn is dosed as ZDZ, 2 mg/kg/dose every 6 hours.