Prevention of Perinatal HIV Transmission in an Area of High HIV Prevalence in the United States

Prevention of Perinatal HIV Transmission in an Area of High HIV Prevalence in the United States

To evaluate the uptake of perinatal HIV preventive interventions by the risk of perinatal HIV transmission in mother–infant pairs in a high–HIV prevalence area in the US. This was a retrospective cohort study of mother–infant pairs with perinatal HIV exposure during 2013-2017 managed at a subspecial...

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Bibliographic Details
Published in:The Journal of pediatrics Vol. 228; pp. 101 - 109
Main Authors: Koay, Wei Li A., Zhang, Jiaqi, Manepalli, Krishna V., Griffith, Caleb J., Castel, Amanda D., Scott, Rachel K., Ferrer, Kathleen T., Rakhmanina, Natella Y.
Format: Journal Article
Language:English
Published: United States Elsevier Inc 01-01-2021
Subjects:
Adult
antiretroviral treatment
cesarean delivery
DNA, Viral - analysis
Female
HIV - genetics
HIV Infections - epidemiology
HIV Infections - prevention & control
Humans
Infant, Newborn
infants
Infectious Disease Transmission, Vertical - prevention & control
Male
mothers
Postpartum Period
Pregnancy
Pregnancy Complications, Infectious - epidemiology
Prevalence
Prognosis
Retrospective Studies
United States - epidemiology
Young Adult
United States
CD
infants
ART
ARV
pregnancy
antiretroviral treatment
HEI
ZDV
PHACS
HHS
mothers
cesarean delivery
SIS
NRTI
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Summary:To evaluate the uptake of perinatal HIV preventive interventions by the risk of perinatal HIV transmission in mother–infant pairs in a high–HIV prevalence area in the US. This was a retrospective cohort study of mother–infant pairs with perinatal HIV exposure during 2013-2017 managed at a subspecialty pediatric HIV program in Washington, DC. We collected demographic data, maternal HIV history, delivery mode, maternal and infant antiretroviral drug (ARV) use, and infant HIV test results. We compared the uptake of recommended preventive interventions in low-risk (ie, mothers on antiretroviral therapy [ART] with viral suppression) and high-risk (mothers without ART or viral suppression) mother–infant pairs using the Pearson chi-square, Fisher exact, and Wilcoxon rank-sum tests and logistic regression. We analyzed 551 HIV-exposed infants (HEIs) and 542 mothers living with HIV. The majority of mothers received ARVs (95.5%), had HIV RNA ≤1000 copies/mL before delivery (81.9%), and received intrapartum zidovudine (ZDV; 65.5%). The majority of all HEIs were low risk (82.6%) and received postpartum ARVs (98.9%). Among the low-risk infants, 53.2% were delivered via cesarean delivery (CD), and 62.9% and 96.5% were administered intrapartum and postpartum ZDV, respectively. Among high-risk infants, 84.4% were delivered via CD, 78.1% received intrapartum ZDV, and 62.5% received combination ART. Nine high-risk infants acquired HIV perinatally. In an area of high HIV prevalence in the US, a large proportion of low-risk HEIs received intrapartum ZDV and were delivered via CD. We also observed missed opportunities for the prevention of perinatal HIV transmission.
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ISSN:0022-3476
1097-6833
1097-6833
DOI:10.1016/j.jpeds.2020.09.041