Perinatal HIV Transmission
Statistics
Key Prevention Strategies
Perinatal HIV Transmission
- Accounts for nearly all pediatric AIDS cases. HIV transmission from mother to child during pregnancy, labor and delivery or by breast feeding accounted for approximately 93% of all AIDS cases reported among U.S. children between 1985 and 2005 (9).
- Can be prevented. Data indicate that when appropriate antiretroviral medications are given during pregnancy, labor and delivery and after birth, the risk of transmission can be reduced to less than 2% (23) compared with approximately 25% when no interventions are given (22).
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Statistics
On a national level, HIV/AIDS surveillance and other studies continue to demonstrate that perinatal HIV prevention efforts are making a difference.
- Pediatric HIV cases
- Between 1991 and 2004, the number of new perinatally acquired HIV cases in the United States declined more than 80% from an estimated 1,650 (41) to an estimated
96 to 186 (44).
- Pediatric AIDS cases
- Between 1992 and 2005, perinatally acquired AIDS cases declined 93% in the United States from 855 cases to 57 cases
(9).
- Prenatal HIV Testing
- Of all HIV-exposed infants reported to CDC through the HIV/AIDS Reporting System (HARS) from
33 areas with confidential name-based perinatal HIV exposure reporting who were reported in 2005, 95% of mothers had known HIV status prior to or at the infant’s birth (11).
- Antiretroviral Use
- Use of zidovudine (ZDV) for prevention of mother-child HIV transmission
in the U.S. increased substantially between 1993 and 2005 (11).
For further information and statistics on perinatal HIV infection in the United States, see:
Sources of Data for States and Other Jurisdictions
HARS
33 jurisdictions currently conduct HIV exposure reporting for newborns. In these jurisdictions, the HIV/AIDS Reporting System (HARS) collects data regarding HIV-exposed infants. These data include the following:
- Demographic information (date of birth, sex, race/ethnicity, etc.)
- Reporting facility
- Prenatal care received (number of visits, HIV testing, ZDV prophylaxis, etc.)
- Infant HIV testing (dates, results)
- Infant’s clinical status (CD4+ cell count/percentage, opportunistic infections, receipt of ZDV and PCP prophylaxis, etc.)
- Birth history (birth weight, etc.)
EPS
Each year since 1999, several sites around the country have been funded to conduct Enhanced Perinatal Surveillance (EPS). Sites funded to conduct EPS have varied each year since the system’s inception in 1999; data for every year are not available at every site. In 2006, 15 jurisdictions were funded. Funded jurisdictions collect data for all HIV-exposed children through chart reviews. These data include the following:
- Demographic information (date of birth, sex, race/ethnicity, etc.)
- Reporting facility
- Prenatal care received (number of visits, HIV testing, ZDV prophylaxis, use of other ARVs etc.)
- Infant HIV testing (detailed data regarding dates and results)
- Infant’s clinical status (Viral loads, CD4+ cell count/percentage, opportunistic infections, receipt of ZDV and other ARVs, viral resistance patterns, receipt of PCP prophylaxis, etc.)
- Birth history (detailed delivery history, birth weight, etc.)
- Mother’s pregnancy history (past pregnancies, infections during pregnancy, drug use history, etc.)
- Sibling data (number of siblings, HIV status, etc.)
PRAMS
The Pregnancy Risk Assessment and Monitoring System (PRAMS) is a survey of women who have recently given birth that is conducted yearly in
37 states, the Yankton Sioux Tribe in South Dakota, and New York City.
PRAMS contacts women directly, either by mail or phone, and collects comprehensive data regarding pregnancies in the jurisdiction, including whether the woman recalls being tested for HIV during her most recent pregnancy.
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Key Prevention Strategies
- Early Diagnosis
- Ideally, all women should be tested for HIV infection as a routine part of their medical care prior to pregnancy.
- Women who become pregnant without knowing their infection status represent important missed opportunities for prevention.
- HIV screening should be a routine component of preconception care for all women.
- Prevent Unplanned Pregnancies and Plan Desired Pregnancies
- Nearly half of all pregnancies in the United States each year are unplanned. Many cases of mother-child transmission could be averted if HIV-infected women who do not desire pregnancy avoided unplanned pregnancy.
- For women with HIV infection who are planning pregnancy, preconception care must focus on maternal infection status, viral load, immune status and therapeutic regimen as well as education regarding perinatal transmission risks and prevention strategies, expectations for the child’s future and where desired, effective contraception until the optimal maternal health status for pregnancy is achieved.
- Specific counseling should be provided as needed regarding assisted reproductive technologies available to prevent HIV exposure to uninfected partners and to prevent superinfection with resistant or more virulent virus.
- Routine, Early Prenatal HIV Testing
- Universal, routine HIV screening of all pregnant women should occur as early as possible during every pregnancy.
- The test should be included in the routine panel of prenatal tests.
- Women should be notified that the test will be performed unless they specifically decline (This strategy is called the “opt-out” approach).
- Approximately 12% of HIV-infected women giving birth between 1999 and 2001 in 24 Enhanced Perinatal Surveillance sites received no prenatal care (15). Many HIV-infected women cite discrimination and discomfort as reasons for avoiding prenatal care (40). Providing accessible, welcoming prenatal care services for all women is an important strategy for prevention of perinatal HIV infection and for providing opportunities to protect women’s health.
- Second HIV Test In the Third Trimester
- Many cases of perinatal HIV transmission have occurred in infants whose mothers had a negative HIV test earlier in pregnancy.
- Universal, routine retesting in the third trimester, preferably before 36 weeks of gestation, has comparable cost-effectiveness to other routine health interventions even in low-prevalence settings and may be considered for all women in the United States.
- A second HIV test in the third trimester is specifically recommended for women at increased risk of HIV infection and for women in certain states and facilities (13).
- Antiretroviral Medications
- Antiretroviral medications including zidovudine (ZDV) should be used as appropriate for the woman’s health and to reduce HIV-1 transmission risk (50).
- Appropriate use of antiretroviral therapy and prophylaxis can reduce the risk of perinatal transmission to less than 2% (50).
- Scheduled Cesarean Delivery
- Scheduled cesarean delivery before onset of labor or rupture of membranes can reduce risk of HIV transmission when maternal serum viral copy numbers are not sufficiently reduced by antiretroviral therapy (50).
- Testing in Labor and Delivery
- Universal, routine rapid HIV testing should be conducted using an opt-out approach for women who arrive at labor and delivery without a documented prenatal HIV test (13).
- Newborn Testing
- Rapid HIV testing of newborns whose mothers were not previously screened for HIV offers a last chance to provide antiretroviral prophylaxis to HIV-exposed infants (13, 17).
- Avoidance of Breastfeeding
- HIV transmission through breast milk accounts for approximately one third of perinatal HIV transmission in populations in which this practice is common (4,
24,
43).
- All HIV-infected mothers in the United States should be counseled to avoid breastfeeding and should have reliable access to a safe, affordable, appropriate
breast milk substitute (50).
- Linkage to HIV Care for Mother and Infant
- HIV-infected women and exposed infants should be supported by linkage with appropriate medical and other services necessary for their own health after delivery.
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