Objective  To analyze the high HIV exposure risk in infants of HIV positive pregnant women and influencing factors in Guangxi Zhuang autonomous region.

  Methods  A total of 2707 infants of HIV positive pregnant women, who were born between January, 2016 and December 31 2020, reported by medical and health care institutions at all levels in Guangxi were selected through National Information System for Mother-to-Child Transmission of AIDS, Syphilis and Hepatitis B Management. The information about their mothers’ demographic characteristics, the time of HIV diagnosis, receipt of health care during pregnancy, receipt of antiviral therapy, and HIV viral load were collected. Through χ² test, univariate analysis and multivariate Logistic regression model was used to analyze the influencing factors of high HIV exposure risk in infants of HIV positive pregnant women.

  Results  A total of 2707 infants were included in the analysis, in whom 2277 had general HIV exposure risk and 430 had high HIV exposure risk. The results of multivariate analysis showed that high education level of HIV positive mother was a protective factor for high HIV exposure risk in infants. Pregnant women diagnosed with HIV infection in pregnancy were more likely to have infants at high risk for HIV exposure compared with those diagnosed before pregnancy (OR=10.928, 95% CI: 8.140–14.671). Compared with the HIV positive pregnant women with the first antenatal examination in early pregnancy, HIV positive pregnant women with the first antenatal examination at late pregnancy were more likely to have infants at high risk for HIV exposure (OR=21.997, 95% CI: 15.253–31.723). The mother-to-child transmission rate of HIV was 13.44% in infants at high HIV exposure risk and 0.43% in those at general HIV exposure risk.

  Conclusion  The diagnosed date of HIV infection and gestational week of the first antenatal examination in HIV positive pregnant women were closely related to the HIV exposure risk level in their infants. Moreover, factors such as age, education level, marital status and delivery history were also related to the level of HIV exposure risk in infants. Targeted health education should be conducted in HIV positive pregnant women and the early detection of HIV infection should be promoted to reduce the high HIV exposure risk in infants.