Letter to Clinicians: Guidelines to Prevent Perinatal HIV Infection
On February 17th, Dr. Jinline Chan, Deputy Secretary of the Maryland Department of Health Public Health Services, issued a letter to clinicians with guidelines to prevent perinatal HIV transmission. The recent increase of HIV in newborns in Maryland is of great concern and the Department is asking all providers to take the necessary steps to reduce perinatal HIV transmissions. Included among these are prenatal care, HIV testing for pregnant persons and their partners, antiretroviral therapy for pregnant persons with HIV, and HIV pre-exposure prophylaxis (PrEP) for persons testing negative.
February 17, 2023
Dear Colleague:
Background and Current Situation
The purpose of this notice is to alert the provider community of a recent, substantial increase in perinatal HIV transmission in Maryland during 2022. The Maryland Department of Health is investigating six recent reports of confirmed perinatal HIV infection. Perinatal HIV transmissions are rare in Maryland. Over the five-year period from 2016-2020, there were only six confirmed transmissions. During 2021, there were 156 confirmed perinatal HIV exposures and zero cases of perinatal HIV infections in babies born in Maryland. Since July 2022, five babies from four different jurisdictions in the state have acquired HIV through perinatal transmission and a sixth perinatal HIV infection was reported in a young child born several years earlier. All six children are currently in care. Review of case data showed that in most cases there was late initiation of prenatal care followed by late or no initiation of HIV antiretroviral therapy (ART). Other maternal risk factors included mental health issues, history of sexually transmitted infections (STIs), and substance use.
Guidelines to Prevent Perinatal HIV Infection
It is important that providers remain vigilant in their efforts to prevent perinatal HIV infection by adhering to the following guidelines:
- Prenatal care is essential for good health outcomes and its importance should be communicated to all sexually active patients who may become pregnant.
- HIV testing is the standard of care for all pregnant persons and is a routine component of preconception care; many pregnant persons are not diagnosed with HIV until they are tested during the pregnancy.
- In Maryland, HIV testing must be offered during both the first and third trimesters, and again at labor and delivery if there is no indication of a test prior to delivery.
- Providers should order HIV testing with an immunoassay that is capable of detecting HIV antibodies and/or antigens (e.g., a 4th generation antigen/antibody combination immunoassay test).
- All pregnant persons with HIV should receive HIV medicines as soon as possible and throughout the pregnancy to prevent perinatal transmission of HIV; risk of perinatal HIV transmission is <1 percent in persons with HIV who initiate ART prior to conception and have sustained HIV viral suppression throughout pregnancy.
- Pre-exposure prophylaxis (PrEP) is a safe treatment for the prevention of HIV in pregnant and breastfeeding persons.
- All sexual partners of pregnant persons should be encouraged to undergo HIV testing if their HIV status is unknown.
Additional Strategies to Reduce and Prevent Perinatal HIV Transmissions
Please consider these important strategies to reduce and prevent perinatal HIV transmissions:
- Encourage routine HIV testing in individuals ages 13 and above
- Communicate the importance of preconception and prenatal care for healthy babies
- Test pregnant persons for HIV, syphilis, hepatitis, and other infectious diseases
- Monitor for acute HIV infection during pregnancy
- Promote infectious disease testing for all partners
- Ensure access to care and supportive services
Resources for Clinicians
- Clinical support is available through the National Clinician Consultation Center (1-888-448-8765).
- Maryland regulations for HIV testing during pregnancy are located here: http://mdrules.elaws.us/comar/10.18.08.07
- A detailed version of the Perinatal Clinical Guidelines is available here: https://clinicalinfo.hiv.gov/en/guidelines/perinatal/whats-new-guidelines
- PrEP Guidelines are located here: https://www.cdc.gov/hiv/clinicians/prevention/prep.html
- To locate PrEP services in Maryland, please refer to: https://npin.cdc.gov/preplocator
- Healthcare providers are required to report to the health department any child born to an HIV positive pregnant person. For assistance with HIV reporting, refer to: https://health.maryland.gov/phpa/OIDEOR/CHSE/Pages/reporting-material.aspx
Thank you for your attention to this important public health matter. We will continue to provide additional updates as needed. If you have questions, please contact mdh.hivdatarequest@maryland.gov.
Sincerely,
Jinlene Chan, MD, MPH, FAAP
Deputy Secretary, Public Health Services