Human immune deficiency virus (HIV) infection is a pandemic, even among pregnant women. It has no cure and so, great importance should be placed on care and support for the sufferer. There is an increasing concern and desire to curb the high incidence of mother to child transmission (MTCT) in Nigeria. Therefore, this study aimed at determining the prevalence and pattern of HIV infection at Imo State University Teaching Hospital, Orlu from 1st January 2009 to 31st December 2013. In this 5 years retrospective hospital-based study, information was obtained from the records of the antenatal clinic, prenatal ward, postnatal clinic and pediatric unit. Of 2727 records of the antenatal care attendees reviewed, 2598 were screened and HIV prevalence was found to be 17.8%. Women aged 31-35 years had the highest age specific prevalence rate (ASPR) of 38.5%, followed closely by age group 26-30 years which recorded ASPR of 35.9%. The lowest ASPR of 1.5% occurred among women aged more than 40 years. The year 2011 recorded the highest HIV prevalence rate of 26.9% while the lowest was in 2009 with a prevalence rate of 11%. All the neonates of booked patients were sero-negative while only 22.2% of their un-booked counterparts tested negative. About 43% of partners of HIV positive women tested positive. Behavioral change communication and expansion of HIV prevention services should be given priority to enhance compliance among the HIV seropositive pregnant women.