Clinical outcomes and postnatal management of infants born to HIV-positive mothers: a retrospective analysis

¹Neonatology and Neonatal Intensive Care Unit, Mohammed V Military Training Hospital, Mohammed V University, Rabat, Morocco, ²Virology Laboratory-CVMIT, Mohammed V Military Training Hospital, Rabat, Morocco

^&Corresponding author
Bahous El Mehdi, Neonatology and Neonatal Intensive Care Unit, Mohammed V Military Training Hospital, Mohammed V University, Rabat, Morocco

Introduction    

Mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) represents one of the main routes of HIV infection in children worldwide. Transmission may occur during pregnancy, labour, delivery, or breastfeeding. Without preventive interventions, the risk of vertical transmission ranges from 15% to 45%. However, comprehensive prevention strategies, including maternal antiretroviral therapy, safe delivery practices, and appropriate postnatal prophylaxis, have significantly reduced this risk to less than 5% in many settings [1].

The postnatal period represents a critical stage in the prevention of HIV transmission. Early neonatal management of HIV-exposed infants includes the administration of antiretroviral prophylaxis, appropriate feeding counselling, clinical monitoring, and early virological testing [2]. These interventions aim not only to reduce the risk of postnatal transmission but also to identify and manage potential neonatal complications associated with maternal HIV infection or antiretroviral exposure.

Despite considerable progress in the prevention of vertical transmission, challenges remain, particularly in resource-limited settings where access to comprehensive care and follow-up may be limited. Evaluating the clinical outcomes of HIV-exposed infants and assessing current postnatal management practices are essential for improving prevention strategies and optimising neonatal care [3]. This study aimed to analyse the postnatal management and early clinical outcomes of infants born to HIV-positive mothers in a tertiary care centre

Methods     

Study design: this was a retrospective descriptive study conducted among neonates born to HIV-positive mothers.

Setting: the study was carried out in the Neonatology Department of the Mohamed V Military Teaching Hospital in Rabat, in collaboration with the Centre for Virology, Infectious and Tropical Diseases. The study period extended from April 2022 to April 2025.

Participants: all newborns born to confirmed HIV-positive mothers and admitted during the study period were screened for eligibility. Newborns were included if complete medical records documenting postnatal care and follow-up were available. Newborns with incomplete clinical data or those lost to follow-up immediately after birth were excluded. A total of nine newborns met the eligibility criteria and were included in the analysis.

Variables: maternal variables included age, prenatal care, antiretroviral therapy during pregnancy, mode of delivery, and maternal viral load when available. Neonatal variables included gestational age at birth, birth weight, sex, and Apgar scores at 1 and 5 minutes. Postnatal variables included neonatal antiretroviral prophylaxis, feeding practices (exclusive breastfeeding or formula feeding), timing of initial virological testing, and clinical outcomes such as prematurity, low birth weight, infections, and other neonatal complications. HIV infection status during follow-up was also assessed.

Data sources/measurement: data were collected retrospectively from maternal and neonatal medical records using a standardised data collection form.

Bias: potential sources of bias included the retrospective design and the small sample size, which may limit the completeness and generalizability of the data.

Study size: the study included all eligible cases during the study period, resulting in a total sample size of nine neonates.

Quantitative variables: continuous variables such as maternal age, gestational age, and birth weight were treated as quantitative variables.

Statistical methods: data analysis was performed using descriptive statistics. Continuous variables were expressed as means and standard deviations, while categorical variables were presented as frequencies and percentages. Given the small sample size, no inferential statistical analysis was performed.

Ethical considerations: the study was conducted in accordance with the principles of the Declaration of Helsinki. Patient confidentiality was ensured through anonymisation of data, and institutional approval was obtained prior to the initiation of the study.

Results     

Participants: a total of nine HIV-exposed neonates born to HIV-positive mothers were included in the study. All eligible participants had complete medical records and were followed up throughout the study period. No cases were excluded after initial inclusion.

Descriptive data: the mean maternal age was 30.6 years (range: 22-38 years), with 4 mothers aged between 25 and 29 years. Six women were married, and six had a low socioeconomic status. Eight pregnancies occurred within marital relationships, and five women were primigravida and primiparous. Antenatal follow-up was considered adequate in seven patients, although two women were diagnosed with HIV late during pregnancy. All women received triple antiretroviral therapy, predominantly based on dolutegravir, lamivudine, and tenofovir. Among women known to be HIV-positive before pregnancy, viral load remained undetectable throughout gestation. At 36 weeks of gestation, eight women had a viral load <400 copies/mL, including seven with undetectable levels (Table 1). All pregnancies reached term, and cesarean delivery was performed in six cases. No maternal or obstetric complications were reported.

Outcome data: all newborns were born at term with favourable immediate adaptation to extrauterine life. Birth weights ranged from 2.900 Kg to 3.700 Kg, with no cases of low birth weight or congenital anomalies (Table 2). No neonatal complications were observed. All newborns received standard immediate postnatal care, including hygiene measures and early clinical assessment. Antiretroviral prophylaxis was initiated immediately after birth in all neonates. Zidovudine monotherapy was administered in seven cases, while enhanced triple therapy with zidovudine, lamivudine, and nevirapine was prescribed in two cases, particularly in infants born to mothers with late HIV diagnosis. Exclusive formula feeding was adopted in all cases, with full adherence.

Main results: early virological testing using PCR at day 3 of life was negative in all newborns. Repeated PCR testing at 1, 3, and 6 months confirmed persistently negative results in all cases. All infants underwent regular clinical, biological, and immunovirological follow-up, with haematological and biochemical parameters remaining within normal ranges. Cotrimoxazole prophylaxis was initiated at 1 month of age in all infants (Table 3). Vaccination was administered according to national guidelines, with temporary deferral of BCG vaccination until HIV infection was excluded.

Other analyses: at 18 months of follow-up, final HIV serology confirmed that all infants were HIV-negative, with no cases of mother-to-child transmission observed in this cohort.

Discussion     

The care of newborns born to mothers living with HIV is a critical component of the overall strategy for preventing mother-to-child transmission (PMTCT). This study provides insight into the management and clinical outcomes of infants born to HIV-positive mothers in a tertiary care setting, with a particular emphasis on neonatal outcomes. The findings demonstrate favourable maternal virological control, optimal neonatal management, and absence of mother-to-child transmission (MTCT) in this cohort [4,5].

In our study, the majority of women achieved adequate virological suppression by the end of pregnancy, with 88.9% presenting a viral load below 400 copies/mL and 77.8% with undetectable levels at 36 weeks of gestation. These findings are consistent with previous studies showing that maternal antiretroviral therapy (ART) significantly reduces the risk of MTCT to less than 1-2% when viral suppression is achieved before delivery [6,7]. According to international guidelines, including those from the World Health Organization (WHO), early initiation and strict adherence to ART remain the most effective interventions for preventing vertical transmission [6].

The mode of delivery in our cohort was predominantly cesarean section, although vaginal delivery was successfully performed in selected cases with controlled viral load [7]. This is in line with current recommendations, which suggest that planned vaginal delivery is safe in women with suppressed viral load, while cesarean section is reserved for cases with higher transmission risk or obstetric indications [8].

Neonatal outcomes in our study were particularly favourable. All newborns were delivered at term, with normal anthropometric parameters and no reported complications. Similar findings have been reported in the literature, where HIV-exposed but uninfected infants generally have outcomes comparable to those of the general population when maternal infection is well controlled and appropriate care is provided [9].

Postnatal management in our cohort adhered to recommended protocols, including early antiretroviral prophylaxis and exclusive formula feeding. The use of enhanced prophylaxis in higher-risk situations, such as late maternal diagnosis, is also supported by international guidelines [9]. Early infant diagnosis using PCR testing at birth and during follow-up is considered the gold standard for detecting HIV infection, allowing for prompt management when necessary [10].

Notably, no cases of MTCT were observed in this study. This result aligns with data from high-performing prevention programs, where transmission rates have been reduced to below 1% through comprehensive strategies combining maternal ART, neonatal prophylaxis, and appropriate feeding practices. These findings reinforce the effectiveness of current prevention approaches when consistently implemented [11].

Despite these encouraging outcomes, several limitations must be acknowledged. The small sample size (n = 9) limits the external validity of the findings. Additionally, the retrospective design may introduce information bias due to incomplete or missing data. Although follow-up until 18 months confirmed the absence of HIV infection, long-term outcomes beyond this period, including growth and neurodevelopment, were not assessed [12].

Nevertheless, this study provides valuable real-world evidence supporting the effectiveness of current MTCT prevention strategies in routine clinical practice [13]. It highlights the importance of early diagnosis, sustained viral suppression, and standardised neonatal care in achieving optimal outcomes [14]. Future research based on larger, prospective cohorts is needed to further validate these findings and to explore long-term outcomes in HIV-exposed but uninfected children.

Conclusion     

This study highlights the importance of appropriate postnatal management of infants born to HIV-positive mothers, including early antiretroviral prophylaxis, adequate feeding strategies, and regular clinical follow-up to reduce the risk of mother-to-child transmission and improve neonatal outcomes. Although the findings provide useful insight into the clinical care of HIV-exposed newborns, the small sample size and retrospective design represent important limitations that may affect the generalizability of the results. Further large-scale prospective studies are needed to better evaluate long-term outcomes and optimise postnatal management strategies for HIV-exposed infants.

Competing interests     

The authors declare no competting interests.

Authors' contributions     

Patient management: El Mehdi Bahous. Data collection: El Mehdi Bahous and Rachid Abi. Manuscript drafting: El Mehdi Bahous and Salahiddine Saghir. Manuscript revision: Rachid Abi, Anass Ayad, Mohamed Sellouti and Rachid Abilkassem. All authors read and approved the final version of the manuscript.

Tables     

Table 1: maternal and obstetric characteristics (n = 9)
Table 2: neonatal characteristics and immediate outcomes (n = 9)
Table 3: postnatal management and follow-up of HIV-exposed Infants (n = 9)

References