Challenges to the elimination of mother-to-child transmission of HIV infection: four case reports.

HIV can be transmitted from an infected mother to her child during pregnancy or labor and postnatally through breast milk. Nearly 25 years after the first documented case of HIV infection, the decrease in perinatal HIV infections in the United States represents a major success in public health. Despite this achievement, several challenges remain in the effort to eliminate mother-to-child transmission of HIV infection. In the state of Nevada, the number of perinatally acquired HIV infections decreased to its lowest in 2003, with only 1 infected infant, compared with the peak in 1998 of 8 infected infants. We report 4 cases of mother-to-child HIV transmission that occurred in Las Vegas between October 2005 and June 2006 and that highlight some of the challenges in reducing the incidence of perinatal infections. A comprehensive, multidisciplinary program that allows for expanded access to prenatal care, rapid HIV testing in labor and delivery for women of unknown HIV serostatus, and close follow-up of exposed infants must be present to sustain the achievements made in the reduction of mother-to-child transmission of HIV infection.