Postpartum Mother-To-Child Transmission of HIV in a Breastfeeding Infant

Mother-to-child transmission of HIV in New York State is rare. We describe the sequence of events leading to HIV diagnosis of a breastfeeding infant whose mother seroconverted postnatally. The infant was born to a married, multiparous woman in her early thirties. Prenatal visits occurred early and at regular intervals during an uncomplicated pregnancy. Maternal serological tests for HIV were negative in the first trimester (4th generation antigen and antibody) and at labor and delivery (3rd generation rapid antibody) and based on the New York State Newborn Screening test, which is used to evaluate for maternal HIV-1 immunoglobulin G antibodies. The mother and infant received routine postnatal care; at 15 weeks postpartum, both presented to health care for evaluation of illness. Maternal symptoms included fever, myalgia, chills, headache, and vomiting; fever, dry cough and posttussive emesis were documented for the infant. The child was concurrently diagnosed with HIV-1 and Pneumocystis jirovecii pneumonia at age 28 weeks after 11 medical care encounters with persistent and deteriorating symptoms. From symptom onset, the mother was evaluated twice for a nonspecific acute viral syndrome. She was diagnosed with HIV-1, 4 days after the infant's diagnosis. We discuss missed opportunities in multiple health care settings for prompt diagnosis of infant and mother, treatment initiation, and preventive counseling across the reproductive health continuum. We provide recommendations to ensure that sexual health messaging, including mitigating HIV-related risks, is routinized for partners as part of prenatal and postpartum care. This article is an examination of MTCT of HIV through breastfeeding in a mother who seroconverted postnatally.