AEGiS-13IAC: Progress towards elimination of perinatal HIV infection in the United States.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Progress towards elimination of perinatal HIV infection in the United States.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. MoOrC239)

Hammett T, Lindegren ML, Byers R, Wortley P, Bi D
T. Hammett, CDC, 1600 Clifton Road, Mailstop E-47, Atlanta, GA 30333, United States, Tel.: +1 404 639 2050, Fax: +1 404 639 2980, E-mail: tah5@cdc.gov

OBJECTIVE: To describe the course of perinatal HIV epidemic in the U.S., assess the impact of maternal and neonatal ZDV use, and missed opportunities to prevent perinatal HIV transmission.

METHODS: We analyzed 1) national perinatally acquired (PA) AIDS data reported by 9/99, adjusting for reporting delays and no reported risk; 2) HIV data from 32 states that monitor perinatally HIV exposed children and their HIV infection and AIDS status; 3) Enhanced perinatal HIV surveillance data on perinatally infected children (prevention failures) from 7 states (CO, IN, LA, MI, MO, NJ, SC)

RESULTS: By yr of AIDS diagnosis, estimated PA AIDS incidence peaked in 1992 and declined 74% from 1993 (N = 867) to 1998 (N = 224). Declines occurred in all regions, urban/rural areas, racial/ethnic groups and especially among infants (>1 yr) (86%). In 32 HIV reporting states, of 6482 reported perinatally exposed children born in 1994-1998, the % of mothers tested for HIV before birth increased from 80% to 96%. Among mothers tested before birth, prenatal ZDV use increased from 30% ('94) to 74% ('97) and then plateaued in '98 (69%); neonatal ZDV increased from 27% ('94) to 84% (98); those receiving all three ZDV components increased from 14% ('94) to 58% ('98). In 1998, 38% received combination therapy in pregnancy. Among children tested for HIV before age two months, the % HIV-infected declined from 20.7% in 1993 to 10.6% in 1997. In 7 states with enhanced surveillance, of 88 HIV-infected children born '96-'97, 16% had mothers first tested for HIV after birth, 35% of mothers used illicit drugs in pregnancy; 28% were >37 weeks gestation; 17% had no prenatal care (PNC); 14% had PNC but no prenatal HIV test, 17% had PNC, prenatal HIV test, but no prenatal ZDV, and 39% had all three ZDV components.

CONCLUSIONS: Dramatic declines in PA AIDS and HIV incidence have continued in the U.S., largely due to declining perinatal transmission with increasing ZDV use. To eliminate perinatal transmission, HIV+ mothers without prenatal care or timely HIV testing need to be targeted. Population-based perinatal HIV exposure and infection surveillance is critical to target and evaluate perinatal elimination efforts.

Keywords: AEGIS, HIV Infections, Zidovudine, HIV Seropositivity, Acquired Immunodeficiency Syndrome, United States, Incidence, Prenatal Care, Greece, Infant, Newborn, Human, Child, Infant, Female, Pregnancy
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