Missed opportunities for perinatal HIV prevention among HIV-exposed infants born 1996-2000, pediatric spectrum of HIV disease cohort

Vicki Peters, Kai Lih Liu, Kenneth Dominguez, Toni Frederick, Sharon Melville, Ho Wen Hsu, Idith Ortiz, Tamara Rakusan, Balwant Gill, Pauline Thomas, Glenn Fowler, Alan Greenberg, Beverly Bohannon, Thom Sukalac, Joyce Cohen, Catherine Reddington, Barbara Stechenberg, Eileen Theroux, Maripat Toye, Stephen PeltonAnne Marie Regan, Sam Theodore, Kenneth McIntosh, Catherine Kneut, Katherine Luzuriaga, Dorothy Smith, Donna Picard, H. Cody Meissner, Gerard Coste, Margaret Lynch, Mark Pasternack, Chere Mapson, Annette Brooks, Myrna Beckles, Patricia Diggs, Stephanie Manning, Carol McFarlane, Karla McFarlane, Arye Rubinstein, Saroj Bakshi, Edward Handelsman, Elaine Abrams, Cathy Painter, Andrew Wiznia, Ninad Desal, Nathan Litman, Joseph Stavola, Jacob Abadi, Hans Spiegel, Andrew Bonwit, Vonterris Hagan-Temple, Waldo Perez, Sohail Rana, Renee Jenkins, Davene McCarthy-White, Linda Hart, Juan Carlos Orengo, Aida Melendez, Myribel Santiago-Torres, Evelyn Rivera, Ruth Santos, Emily Maldonado, Eleanor Jimenez, Luis A. Martinez, Irma Febo, Lissette Lugo, Wanda Figueroa, Odette Garcia, Jose Vazquez Julia, Rosa Delgado, Ortando Quincoce, Judith Gautier, Marcia Wolverton, Richard Yeager, Mary James, Janet Squires, Janeen Graper, Terence Doran, Rachel Davis, Mary Jane Varela, Gilberto Handel, Tony Millon, Marilyn Doyle, Kathleen Paul, Mary Paul, Amy Leonard, Janak Patel, Patti Forey, Saramistha Hauger, Laurene Mascola, Silvia Shin, Janielle Jackson-Alvarez, Priya Mukhopadhyay, Yvonne Bryson, Joseph Church, Audra Deveikis, Margaret Keller, Deborah Lehman, Andrea Kovacs

Research output: Contribution to journalArticlepeer-review

80 Scopus citations

Abstract

Objective. Despite dramatic reductions in perinatal human immunodeficiency virus (HIV) transmission in the United States, obstacles to perinatal HIV prevention that include lack of prenatal care; failure to test pregnant women for HIV before delivery; and lack of prenatal, intrapartum, or neonatal antiretroviral (ARV) use remain. The objective of this study was to describe trends in perinatal HIV prevention methods, perinatal transmission rates, and the contribution of missed opportunities for perinatal HIV prevention to perinatal HIV infection. Methods. We analyzed data obtained from infant medical records on 4755 HIV-exposed singleton deliveries in 1996-2000, from 6 US sites that participate in the Centers for Disease Control and Prevention's Pediatric Spectrum of HIV Disease Project. HIV-exposed deliveries refer to deliveries in which the mother was known to have HIV infection during the pregnancy. Results. Of the 4287 women with data on prenatal care, 92% had prenatal care. From 1996 to 2000, among the 3925 women with prenatal care, 92% had an HIV test before delivery; the use of prenatal zidovudine (ZDV) alone decreased from 71% to 9%, and the use of prenatal ZDV with other ARVs increased from 6% to 70%. Complete data on maternal and neonatal ARVs were available for 3284 deliveries. Perinatal HIV transmission was 3% in 1651 deliveries with prenatal ZDV in combination with other ARVs, intrapartum ZDV, and neonatal ZDV; 6% in 1111 deliveries with prenatal, intrapartum, and neonatal ZDV alone; 8% in 152 deliveries with intrapartum and neonatal ZDV alone; 14% of 73 deliveries with neonatal ZDV only started within 24 hours of birth; and 20% in 297 deliveries with no prenatal, intrapartum, and neonatal ARVs. Complete data on prenatal events were available in 328 HIV-infected and 3258 HIV-uninfected infants. A total of 56% of mothers of HIV-infected infants had missed opportunities for perinatal HIV prevention versus 16% of mothers of HIV-uninfected infants. Forty-four percent of the infected infants were born to mothers who had prenatal care, a prenatal HIV diagnosis, and documented prenatal ARV therapy. Seventeen percent of women with reported illicit drug use had no prenatal care versus 3% of women with no reported drug use. In a multivariate analysis, maternal illicit drug use was significantly associated with lack of prenatal care. In a multivariate analysis, year of infant birth and the combination of lack of maternal HIV testing before delivery and lack of prenatal antiretroviral therapies were significantly associated with perinatal HIV transmission. Conclusions. Missed opportunities for perinatal HIV prevention contributed to more than half of the cases of HIV-infected infants. Prenatal care and HIV testing before delivery are major opportunities for perinatal HIV prevention. Illicit drug use was highly associated with lack of prenatal care, and lack of HIV testing before delivery was highly associated with perinatal HIV transmission.

Original languageEnglish (US)
Pages (from-to)1186-1191
Number of pages6
JournalPediatrics
Volume111
Issue number5 II
StatePublished - May 1 2003

Keywords

  • Missed opportunities for perinatal HIV prevention
  • Pediatric HIV infection
  • Perinatal HIV prevention

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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