Current Challenges in Vertical HIV Transmission: Early Diagnosis and Prevention Strategies in the Pediatric Population

Abstract

Introduction: Vertical transmission of the human immunodeficiency virus (HIV) is the leading cause of HIV infection in children and remains a major public health challenge despite significant advances in prevention. Antiretroviral therapy during pregnancy, early maternal diagnosis, and neonatal prophylaxis have substantially reduced transmission rates; however, late diagnosis, poor treatment adherence, and inequalities in access to healthcare continue to hinder the elimination of pediatric HIV infection. Objective: To analyze the scientific evidence regarding the current challenges of vertical HIV transmission, emphasizing early diagnosis and prevention strategies in the pediatric population. Methods: This integrative literature review was conducted according to the PRISMA recommendations. Searches were performed in the PubMed/MEDLINE, SciELO, and Virtual Health Library databases using descriptors related to vertical HIV transmission, early diagnosis, and pediatrics. A total of 51 studies were identified, and seven met the eligibility criteria and were included in the final analysis. Results: The selected studies demonstrated a significant reduction in vertical HIV transmission following the expansion of antiretroviral therapy, prenatal care, and neonatal prophylaxis. Nevertheless, important challenges remain, including maternal seroconversion during pregnancy and breastfeeding, inadequate prenatal care, delayed diagnosis, loss to follow-up of HIV-exposed children, and structural inequalities among healthcare systems. Conclusion: Eliminating vertical HIV transmission requires expanded early diagnosis, universal access to antiretroviral therapy, improved maternal and child healthcare, and strengthened public health policies aimed at continuous follow-up of pregnant women and HIV-exposed children.