![]() The infant was next evaluated at 23 weeks, with a primary complaint of lingering cough. We discuss missed opportunities for prompt diagnosis for mother and infant and provide recommendations on identifying HIV infection across the reproductive health continuum. 5 In this report, we describe an infant, presumed unexposed to HIV at birth, who acquired HIV through breastfeeding from the mother who seroconverted postnatally. 2– 4 The result is that, on average, 96% of pregnant people giving birth in NYS are aware of their HIV status and only 22 liveborn infants in NYS were perinatally infected with HIV in the past decade (rate: 0–1.3 of 100 000 live births 2010-2019). Early in the HIV epidemic, New York State (NYS) implemented universal opt-out prenatal testing, expedited testing at delivery of women without documented prenatal testing, mandatory HIV antibody screening of newborns via the NYS Newborn Screening (NBS) program, and access to antiretroviral therapy (ART) for infected mothers and exposed infants to minimize the seroconversion of HIV-exposed infants. ![]() 1 Nonetheless, it is critical to understand each transmission to identify missed opportunities among the most common but difficult to prevent cases. Mother-to-child transmission (MTCT) of HIV in the United States is infrequent. 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. 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. She was diagnosed with HIV-1, 4 days after the infant’s diagnosis. From symptom onset, the mother was evaluated twice for a nonspecific acute viral syndrome. 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. Maternal symptoms included fever, myalgia, chills, headache, and vomiting fever, dry cough and posttussive emesis were documented for the infant. The mother and infant received routine postnatal care at 15 weeks postpartum, both presented to health care for evaluation of illness. ![]() ![]() 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. Prenatal visits occurred early and at regular intervals during an uncomplicated pregnancy. The infant was born to a married, multiparous woman in her early thirties. We describe the sequence of events leading to HIV diagnosis of a breastfeeding infant whose mother seroconverted postnatally. Mother-to-child transmission of HIV in New York State is rare. ![]()
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