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 journalArticle

79 Citations (Scopus)

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

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Virus Diseases
HIV
Pediatrics
Prenatal Care
Zidovudine
Mothers
Street Drugs
Multivariate Analysis
Parturition

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health

Keywords

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

Cite this

Peters, V., Liu, K. L., Dominguez, K., Frederick, T., Melville, S., Hsu, H. W., ... Kovacs, A. (2003). Missed opportunities for perinatal HIV prevention among HIV-exposed infants born 1996-2000, pediatric spectrum of HIV disease cohort. Pediatrics, 111(5 II), 1186-1191.
Peters, Vicki ; Liu, Kai Lih ; Dominguez, Kenneth ; Frederick, Toni ; Melville, Sharon ; Hsu, Ho Wen ; Ortiz, Idith ; Rakusan, Tamara ; Gill, Balwant ; Thomas, Pauline ; Fowler, Glenn ; Greenberg, Alan ; Bohannon, Beverly ; Sukalac, Thom ; Cohen, Joyce ; Reddington, Catherine ; Stechenberg, Barbara ; Theroux, Eileen ; Toye, Maripat ; Pelton, Stephen ; Regan, Anne Marie ; Theodore, Sam ; McIntosh, Kenneth ; Kneut, Catherine ; Luzuriaga, Katherine ; Smith, Dorothy ; Picard, Donna ; Meissner, H. Cody ; Coste, Gerard ; Lynch, Margaret ; Pasternack, Mark ; Mapson, Chere ; Brooks, Annette ; Beckles, Myrna ; Diggs, Patricia ; Manning, Stephanie ; McFarlane, Carol ; McFarlane, Karla ; Rubinstein, Arye ; Bakshi, Saroj ; Handelsman, Edward ; Abrams, Elaine ; Painter, Cathy ; Wiznia, Andrew ; Desal, Ninad ; Litman, Nathan ; Stavola, Joseph ; Abadi, Jacob ; Spiegel, Hans ; Bonwit, Andrew ; Hagan-Temple, Vonterris ; Perez, Waldo ; Rana, Sohail ; Jenkins, Renee ; McCarthy-White, Davene ; Hart, Linda ; Orengo, Juan Carlos ; Melendez, Aida ; Santiago-Torres, Myribel ; Rivera, Evelyn ; Santos, Ruth ; Maldonado, Emily ; Jimenez, Eleanor ; Martinez, Luis A. ; Febo, Irma ; Lugo, Lissette ; Figueroa, Wanda ; Garcia, Odette ; Vazquez Julia, Jose ; Delgado, Rosa ; Quincoce, Ortando ; Gautier, Judith ; Wolverton, Marcia ; Yeager, Richard ; James, Mary ; Squires, Janet ; Graper, Janeen ; Doran, Terence ; Davis, Rachel ; Jane Varela, Mary ; Handel, Gilberto ; Millon, Tony ; Doyle, Marilyn ; Paul, Kathleen ; Paul, Mary ; Leonard, Amy ; Patel, Janak ; Forey, Patti ; Hauger, Saramistha ; Mascola, Laurene ; Shin, Silvia ; Jackson-Alvarez, Janielle ; Mukhopadhyay, Priya ; Bryson, Yvonne ; Church, Joseph ; Deveikis, Audra ; Keller, Margaret ; Lehman, Deborah ; Kovacs, Andrea. / Missed opportunities for perinatal HIV prevention among HIV-exposed infants born 1996-2000, pediatric spectrum of HIV disease cohort. In: Pediatrics. 2003 ; Vol. 111, No. 5 II. pp. 1186-1191.
@article{b546a6b06d8740f795bf7306aaa3917c,
title = "Missed opportunities for perinatal HIV prevention among HIV-exposed infants born 1996-2000, pediatric spectrum of HIV disease cohort",
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.",
keywords = "Missed opportunities for perinatal HIV prevention, Pediatric HIV infection, Perinatal HIV prevention",
author = "Vicki Peters and Liu, {Kai Lih} and Kenneth Dominguez and Toni Frederick and Sharon Melville and Hsu, {Ho Wen} and Idith Ortiz and Tamara Rakusan and Balwant Gill and Pauline Thomas and Glenn Fowler and Alan Greenberg and Beverly Bohannon and Thom Sukalac and Joyce Cohen and Catherine Reddington and Barbara Stechenberg and Eileen Theroux and Maripat Toye and Stephen Pelton and Regan, {Anne Marie} and Sam Theodore and Kenneth McIntosh and Catherine Kneut and Katherine Luzuriaga and Dorothy Smith and Donna Picard and Meissner, {H. Cody} and Gerard Coste and Margaret Lynch and Mark Pasternack and Chere Mapson and Annette Brooks and Myrna Beckles and Patricia Diggs and Stephanie Manning and Carol McFarlane and Karla McFarlane and Arye Rubinstein and Saroj Bakshi and Edward Handelsman and Elaine Abrams and Cathy Painter and Andrew Wiznia and Ninad Desal and Nathan Litman and Joseph Stavola and Jacob Abadi and Hans Spiegel and Andrew Bonwit and Vonterris Hagan-Temple and Waldo Perez and Sohail Rana and Renee Jenkins and Davene McCarthy-White and Linda Hart and Orengo, {Juan Carlos} and Aida Melendez and Myribel Santiago-Torres and Evelyn Rivera and Ruth Santos and Emily Maldonado and Eleanor Jimenez and Martinez, {Luis A.} and Irma Febo and Lissette Lugo and Wanda Figueroa and Odette Garcia and {Vazquez Julia}, Jose and Rosa Delgado and Ortando Quincoce and Judith Gautier and Marcia Wolverton and Richard Yeager and Mary James and Janet Squires and Janeen Graper and Terence Doran and Rachel Davis and {Jane Varela}, Mary and Gilberto Handel and Tony Millon and Marilyn Doyle and Kathleen Paul and Mary Paul and Amy Leonard and Janak Patel and Patti Forey and Saramistha Hauger and Laurene Mascola and Silvia Shin and Janielle Jackson-Alvarez and Priya Mukhopadhyay and Yvonne Bryson and Joseph Church and Audra Deveikis and Margaret Keller and Deborah Lehman and Andrea Kovacs",
year = "2003",
month = "5",
day = "1",
language = "English (US)",
volume = "111",
pages = "1186--1191",
journal = "Pediatrics",
issn = "0031-4005",
publisher = "American Academy of Pediatrics",
number = "5 II",

}

Peters, V, Liu, KL, Dominguez, K, Frederick, T, Melville, S, Hsu, HW, Ortiz, I, Rakusan, T, Gill, B, Thomas, P, Fowler, G, Greenberg, A, Bohannon, B, Sukalac, T, Cohen, J, Reddington, C, Stechenberg, B, Theroux, E, Toye, M, Pelton, S, Regan, AM, Theodore, S, McIntosh, K, Kneut, C, Luzuriaga, K, Smith, D, Picard, D, Meissner, HC, Coste, G, Lynch, M, Pasternack, M, Mapson, C, Brooks, A, Beckles, M, Diggs, P, Manning, S, McFarlane, C, McFarlane, K, Rubinstein, A, Bakshi, S, Handelsman, E, Abrams, E, Painter, C, Wiznia, A, Desal, N, Litman, N, Stavola, J, Abadi, J, Spiegel, H, Bonwit, A, Hagan-Temple, V, Perez, W, Rana, S, Jenkins, R, McCarthy-White, D, Hart, L, Orengo, JC, Melendez, A, Santiago-Torres, M, Rivera, E, Santos, R, Maldonado, E, Jimenez, E, Martinez, LA, Febo, I, Lugo, L, Figueroa, W, Garcia, O, Vazquez Julia, J, Delgado, R, Quincoce, O, Gautier, J, Wolverton, M, Yeager, R, James, M, Squires, J, Graper, J, Doran, T, Davis, R, Jane Varela, M, Handel, G, Millon, T, Doyle, M, Paul, K, Paul, M, Leonard, A, Patel, J, Forey, P, Hauger, S, Mascola, L, Shin, S, Jackson-Alvarez, J, Mukhopadhyay, P, Bryson, Y, Church, J, Deveikis, A, Keller, M, Lehman, D & Kovacs, A 2003, 'Missed opportunities for perinatal HIV prevention among HIV-exposed infants born 1996-2000, pediatric spectrum of HIV disease cohort', Pediatrics, vol. 111, no. 5 II, pp. 1186-1191.

Missed opportunities for perinatal HIV prevention among HIV-exposed infants born 1996-2000, pediatric spectrum of HIV disease cohort. / Peters, Vicki; Liu, Kai Lih; Dominguez, Kenneth; Frederick, Toni; Melville, Sharon; Hsu, Ho Wen; Ortiz, Idith; Rakusan, Tamara; Gill, Balwant; Thomas, Pauline; Fowler, Glenn; Greenberg, Alan; Bohannon, Beverly; Sukalac, Thom; Cohen, Joyce; Reddington, Catherine; Stechenberg, Barbara; Theroux, Eileen; Toye, Maripat; Pelton, Stephen; Regan, Anne Marie; Theodore, Sam; McIntosh, Kenneth; Kneut, Catherine; Luzuriaga, Katherine; Smith, Dorothy; Picard, Donna; Meissner, H. Cody; Coste, Gerard; Lynch, Margaret; Pasternack, Mark; Mapson, Chere; Brooks, Annette; Beckles, Myrna; Diggs, Patricia; Manning, Stephanie; McFarlane, Carol; McFarlane, Karla; Rubinstein, Arye; Bakshi, Saroj; Handelsman, Edward; Abrams, Elaine; Painter, Cathy; Wiznia, Andrew; Desal, Ninad; Litman, Nathan; Stavola, Joseph; Abadi, Jacob; Spiegel, Hans; Bonwit, Andrew; Hagan-Temple, Vonterris; Perez, Waldo; Rana, Sohail; Jenkins, Renee; McCarthy-White, Davene; Hart, Linda; Orengo, Juan Carlos; Melendez, Aida; Santiago-Torres, Myribel; Rivera, Evelyn; Santos, Ruth; Maldonado, Emily; Jimenez, Eleanor; Martinez, Luis A.; Febo, Irma; Lugo, Lissette; Figueroa, Wanda; Garcia, Odette; Vazquez Julia, Jose; Delgado, Rosa; Quincoce, Ortando; Gautier, Judith; Wolverton, Marcia; Yeager, Richard; James, Mary; Squires, Janet; Graper, Janeen; Doran, Terence; Davis, Rachel; Jane Varela, Mary; Handel, Gilberto; Millon, Tony; Doyle, Marilyn; Paul, Kathleen; Paul, Mary; Leonard, Amy; Patel, Janak; Forey, Patti; Hauger, Saramistha; Mascola, Laurene; Shin, Silvia; Jackson-Alvarez, Janielle; Mukhopadhyay, Priya; Bryson, Yvonne; Church, Joseph; Deveikis, Audra; Keller, Margaret; Lehman, Deborah; Kovacs, Andrea.

In: Pediatrics, Vol. 111, No. 5 II, 01.05.2003, p. 1186-1191.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Missed opportunities for perinatal HIV prevention among HIV-exposed infants born 1996-2000, pediatric spectrum of HIV disease cohort

AU - Peters, Vicki

AU - Liu, Kai Lih

AU - Dominguez, Kenneth

AU - Frederick, Toni

AU - Melville, Sharon

AU - Hsu, Ho Wen

AU - Ortiz, Idith

AU - Rakusan, Tamara

AU - Gill, Balwant

AU - Thomas, Pauline

AU - Fowler, Glenn

AU - Greenberg, Alan

AU - Bohannon, Beverly

AU - Sukalac, Thom

AU - Cohen, Joyce

AU - Reddington, Catherine

AU - Stechenberg, Barbara

AU - Theroux, Eileen

AU - Toye, Maripat

AU - Pelton, Stephen

AU - Regan, Anne Marie

AU - Theodore, Sam

AU - McIntosh, Kenneth

AU - Kneut, Catherine

AU - Luzuriaga, Katherine

AU - Smith, Dorothy

AU - Picard, Donna

AU - Meissner, H. Cody

AU - Coste, Gerard

AU - Lynch, Margaret

AU - Pasternack, Mark

AU - Mapson, Chere

AU - Brooks, Annette

AU - Beckles, Myrna

AU - Diggs, Patricia

AU - Manning, Stephanie

AU - McFarlane, Carol

AU - McFarlane, Karla

AU - Rubinstein, Arye

AU - Bakshi, Saroj

AU - Handelsman, Edward

AU - Abrams, Elaine

AU - Painter, Cathy

AU - Wiznia, Andrew

AU - Desal, Ninad

AU - Litman, Nathan

AU - Stavola, Joseph

AU - Abadi, Jacob

AU - Spiegel, Hans

AU - Bonwit, Andrew

AU - Hagan-Temple, Vonterris

AU - Perez, Waldo

AU - Rana, Sohail

AU - Jenkins, Renee

AU - McCarthy-White, Davene

AU - Hart, Linda

AU - Orengo, Juan Carlos

AU - Melendez, Aida

AU - Santiago-Torres, Myribel

AU - Rivera, Evelyn

AU - Santos, Ruth

AU - Maldonado, Emily

AU - Jimenez, Eleanor

AU - Martinez, Luis A.

AU - Febo, Irma

AU - Lugo, Lissette

AU - Figueroa, Wanda

AU - Garcia, Odette

AU - Vazquez Julia, Jose

AU - Delgado, Rosa

AU - Quincoce, Ortando

AU - Gautier, Judith

AU - Wolverton, Marcia

AU - Yeager, Richard

AU - James, Mary

AU - Squires, Janet

AU - Graper, Janeen

AU - Doran, Terence

AU - Davis, Rachel

AU - Jane Varela, Mary

AU - Handel, Gilberto

AU - Millon, Tony

AU - Doyle, Marilyn

AU - Paul, Kathleen

AU - Paul, Mary

AU - Leonard, Amy

AU - Patel, Janak

AU - Forey, Patti

AU - Hauger, Saramistha

AU - Mascola, Laurene

AU - Shin, Silvia

AU - Jackson-Alvarez, Janielle

AU - Mukhopadhyay, Priya

AU - Bryson, Yvonne

AU - Church, Joseph

AU - Deveikis, Audra

AU - Keller, Margaret

AU - Lehman, Deborah

AU - Kovacs, Andrea

PY - 2003/5/1

Y1 - 2003/5/1

N2 - 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.

AB - 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.

KW - Missed opportunities for perinatal HIV prevention

KW - Pediatric HIV infection

KW - Perinatal HIV prevention

UR - http://www.scopus.com/inward/record.url?scp=0037964400&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0037964400&partnerID=8YFLogxK

M3 - Article

C2 - 12728136

VL - 111

SP - 1186

EP - 1191

JO - Pediatrics

JF - Pediatrics

SN - 0031-4005

IS - 5 II

ER -

Peters V, Liu KL, Dominguez K, Frederick T, Melville S, Hsu HW et al. Missed opportunities for perinatal HIV prevention among HIV-exposed infants born 1996-2000, pediatric spectrum of HIV disease cohort. Pediatrics. 2003 May 1;111(5 II):1186-1191.