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Multicenter Study
. 2021 Jan:228:101-109.
doi: 10.1016/j.jpeds.2020.09.041. Epub 2020 Sep 21.

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

Wei Li A Koay  1 , Jiaqi Zhang  2 , Krishna V Manepalli  3 , Caleb J Griffith  3 , Amanda D Castel  4 , Rachel K Scott  5 , Kathleen T Ferrer  6 , Natella Y Rakhmanina  7
Affiliations
Multicenter Study

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

Wei Li A Koay et al. J Pediatr. 2021 Jan.

Abstract

Objective: 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.

Study design: 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.

Results: 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.

Conclusion: 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.

Keywords: antiretroviral treatment; cesarean delivery; infants; mothers; pregnancy.

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Conflict of interest statement

Conflicts of Interest: No authors have conflicts of interests or disclosures.

Figures

Figure 1.
Figure 1.. Proportions of a) low-risk and b) high-risk infants that received intrapartum zidovudine (ZDV), had cesarean delivery (CD), received >4 weeks of antiretroviral (ARV) prophylaxis, received combination ARV prophylaxis (2013–2017).
The top panel (a) shows the proportion of low-risk infants born from 2013 to 2017 who received intrapartum ZDV (clear bars), had CD (solid grey bars), received >4 weeks duration of ARV prophylaxis (diagonal black stripes), and received combination ARV (solid black bars). The bottom panel (b) shows the proportion of high-risk infants born from 2013 to 2017 who received intrapartum ZDV (clear bars), had CD (solid grey bars), received >4 weeks duration of ARV prophylaxis (diagonal black stripes), and received combination ARV prophylaxis (solid black bars). Abbreviations: ARV, antiretroviral; CD, cesarean delivery; LR, low-risk; HR, high-risk; ZDV, zidovudine.
See this image and copyright information in PMC

References

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