Perinatal HIV Infection in Infants Drops but Missed Opportunities for Prevention Remain
Fewer expectant mothers infected with HIV transmit the virus to their babies, but gaps in treatment persist. More infants could be protected with proper screening and treatment.
Transmission of the HIV virus from mothers to babies in the period just before or after they’re born is less common than it used to be, but more infants could be protected with proper screening and treatment: This is the conclusion of the authors of a recent study published in JAMA Pediatrics.
Researchers at the Centers for Disease Control and Prevention (CDC) examined data on infants who were perinatally infected with HIV in the United States from 2002 to 2013. In 2002, the number of babies infected was 216, a number that had dropped to 69 by 2013. Presumably, the reduction in the rate of transmission was due to interventions in the healthcare community. As early as 1985, the CDC recommended that women with HIV avoid breastfeeding their babies; by 1995, many pregnant HIV-positive women were receiving antiretroviral therapies; and around that same time, prenatal testing for HIV became commonplace. In 2006, the CDC recommended universal HIV testing as the default for all pregnant women, with an opt-out choice for those who didn’t want the testing. By the late 1990s, more efficient medications further reduced the burden of HIV in pregnant women. Physicians found that when managed well, HIV viral levels in a mother’s body can be suppressed to the point that transmission of the disease to her baby is extremely unlikely.
Managing the disease, however, is often easier said than done. According to the authors, during the study period almost half of the expectant mothers (48.9%) had missed prenatal visits or had an unknown number of prenatal visits. Slightly more than 11% had no prenatal care visits at all, a percentage that increased from 9.7% for the period from 2002 to 2005, to 16.7% between 2010 and 2013.
Fortunately, the trend showed that HIV infections analyzed during the study periods were diagnosed earlier as the study years progressed—37.5% of pregnant women were diagnosed with HIV before becoming pregnant during the earlier years of the study, while 51.5% of women knew of their diagnosis pre-pregnancy during the study’s later years. Expectant mothers took prenatal antiretroviral medications at a rate of 28.4% during the early years of the study, which increased to 40.3% during the later years of the study.
Diagnosis and treatment rates differed depending on geographical location and ethnic group. The scientists discovered that a disproportionate number of babies infected with HIV were born in southern states such as Texas, Georgia, and Florida, a trend that mirrors the higher incidence of HIV in the South.
“In the southern states with higher HIV prevalence, repeat prenatal testing late in pregnancy is an important strategy for identifying maternal acute HIV infection during pregnancy, an especially vulnerable time for perinatal transmission,” Steve Nesheim, MD, a medical officer in the CDC’s Division of HIV/AIDS Prevention and an author of the study told Contagion®. Also noteworthy is that an outsize share of infected babies were born to women who are African-American (63%) and Latino (18.3%), which corresponds to the higher numbers of infected women in those communities.
Diagnosing HIV in all women and their partners before they conceive can go a long way toward reducing the number of infected babies. “Medical providers caring for people living with HIV should make it a point to address the reproductive health of adult women and men in their care,” asserts Dr. Nesheim. “Providers should comprehensively address all medical issues of women who desire to become pregnant in the near future. This encounter includes ensuring that women living with HIV receive effective antiretroviral treatment. Preconception care is also an opportunity to encourage women to continue effective HIV therapy not only during pregnancy but afterward, in the postpartum period.” He acknowledges that ensuring women get tested and keeping those who are infected on their medication regimens “can be a challenge.”
Although the vast majority of individuals who contract HIV are male, women made up 19% of the new HIV infections in the United States in 2015 and now account for 23% of all infected people in this country.
Laurie Saloman, MS, is a health writer with more than 20 years of experience working for both consumer and physician-focused publications. She is a graduate of Brandeis University and the Medill School of Journalism at Northwestern University. She lives in New Jersey with her family.