14th International AIDS Conference Barcelona, Spain — July 7-12, 2002

Int Conf AIDS. 2002 Jul 7-12;14:Abstract No. ThOrD1429

BACKGROUND: We describe trends in perinatal HIV prevention methods, transmission rates, and the contribution of missed opportunities of prevention in infants enrolled in CDC's Pediatric Spectrum of HIV Disease Project (PSD).

METHODS: We analyzed data from infant medical records on 5,054 HIV-exposed deliveries, 1996-00, from 6 U.S. sites in the PSD project.

RESULTS: Overall, 423 (8.4%) infants were HIV-infected (HIV+), 3,706 (73.3%) HIV-uninfected (HIV-), and 925 (18.3%) HIV-indeterminate. 92% of 4,409 women with data on prenatal care (PNC) had PNC. Lack of PNC was associated with maternal intravenous and street drug use: 17% of 1,119 women with reported drug use had no PNC vs. 5% of 3,935 women with no reported drug use (O.R. 4.0, 95% C.I. 3.2-5.0). 90% of 4,038 women with PNC had a prenatal (PN) HIV test. From 1996-00, use of PN zidovudine (ZDV) alone decreased from 59% to 9% and use of PN ZDV with other antiretrovirals (ARVs) (combo ZDV) increased from 4% to 63%. 3,215 deliveries had complete data on maternal and neonatal (neo) ARVs: perinatal HIV transmission was 2.5% in 1,699 deliveries with PN combo ZDV + intrapartum (IP) ZDV+ neo ZDV, 5.4% in 1,101 deliveries with PN ZDV + IP ZDV + neo ZDV and 28% in 415 deliveries with no PN, IP, and neo ARVs. Complete data on prenatal events were available in 306 HIV+ and 3,129 HIV-infants. 57% of mothers of HIV+ infants had missed opportunities for perinatal HIV prevention (19% lacked PNC; 29% had PNC but had no PN HIV test; and 9% tested prenatally did not receive ARVs) vs. 16% of mothers of HIV- infants (8% lacked PNC; 4% had PNC but had no PN HIV test; and 4% tested prenatally did not receive ARVs) (OR 6.82, 95% C.I. 5.3-8.8).

CONCLUSIONS: Missed opportunities for perinatal HIV prevention contributed to over half of cases of HIV+ infants. Lack of PNC, highly associated with drug abuse, and lack of PN HIV testing are major missed opportunities for perinatal HIV prevention.

Presenting author: V B Peters

1New York City, Department of Health, 346 Broadway, Room 706, New York, New York, United States

2Centers for Disease Control and Prevention, Atlanta, GA, United States

3Los Angeles County Department of Health Services, Los Angeles, CA, United States

4Texas Department of Health, Austin, TX, United States

5Massachusetts State Laboratories Institute, Jamaica Plain, MA, United States

6Departamento de Salud, San Juan, PR, United States

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ThOrD1429

Copyright © 2002 - International AIDS Society (IAS). Reproduction of this abstract (other than one copy for personal reference) must be cleared through the IAS.