HIV Seroconversion During Pregnancy and Mother-to-Child HIV Transmission: Data from the Enhanced Perinatal Surveillance Project, United States, 2005-2010
Lead Author: Sonia Singh
Summary: Dr. Singh and her colleagues examined the number of HIV-positive women who seroconverted during pregnancy (vs. prior to pregnancy), and the associated rate of mother-to-child HIV transmission (MTCT), using data from CDC's Enhanced Perinatal Surveillance. Among the 10,308 HIV-positive women who had live births from 2005-2010 in 15 U.S. areas, 1.2% (124) seroconverted during pregnancy, 70.2% (7,235) seroconverted prior to pregnancy, and 28.6% (2,949) were not able to be classified. Researchers noted a statistically significant 25% annual increase in women who seroconverted during pregnancy (CI:12.3% - 39.1%) and found that while MTCT occurred in only 2% of births overall, it occurred eight times more frequently among women who seroconverted during pregnancy (12.9% vs. 1.6%; Z=9.3, p<0.0001). The authors suggest that efforts to consistently conduct early prenatal HIV testing, along with repeat third-trimester testing, should be enhanced to ensure provision of MTCT interventions.
Relevance: Mother-to-child HIV transmission (MTCT) has been one of the great successes of HIV prevention in the United States over the past decades. In the early 1990s, over 1,500 infants were born annually with HIV acquired from their mothers. That number has fallen to under 200 annually. In 2006, CDC published “Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings.” These recommendations called for routine opt-out HIV screening for all pregnant women, with repeat HIV screening in the third trimester for women who meet 1 or more of 4 criteria (for example, women at high risk and women who receive health care in jurisdictions with elevated rates of HIV infection among women). Women whose HIV status is unknown at the time of labor should be offered opt-out screening with a rapid HIV test. This study highlights a significant increase in HIV seroconversion during pregnancy, a situation that could be detected through HIV testing during the third trimester or at the time of labor and delivery, when efforts can be made to reduce the risk of infection for the newborn and to protect the health of the mother. Antiretroviral therapy administered to the mother during pregnancy, labor and delivery, and also to the newborn, as well as elective cesarean section for women with high viral loads (more than 1,000 copies/ml), can reduce the rate of perinatal HIV transmission to 2% or less. If medications are started during labor and delivery, the rate of perinatal transmission can still be decreased to less than 10%.
See more on CDC HIV Testing Recommendations.Abstract | |
THAC0104 - Oral Abstract
HIV seroconversion during pregnancy and mother-to-child HIV transmission: data from the Enhanced Perinatal Surveillance Project, United States, 2005-2010
Presented by Sonia Singh (United States).S. Singh1, M.A. Lampe1, A. Surendera Babu2, S. Rao1, C.B. Borkowf1, S.R. Nesheim1
1Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, United States, 2ICF International, Atlanta, United States
 |
|
|
Background: In the United States (US), HIV screening is recommended for all pregnant women. Repeat screening is recommended in jurisdictions with elevated rates of HIV and for women with known HIV risk. This study examined the numbers of women seroconverting prior to pregnancy (PTP) and during pregnancy (DP) and the associated mother-to-child HIV transmission (MCT).
Methods: Data from HIV-infected women who delivered live infants from 2005-2010 in 15 US areas that conduct the Centers for Disease Control and Prevention's Enhanced Perinatal Surveillance (EPS) were used. EPS data were linked with National HIV Surveillance data reported through June 2011 to replace missing test dates. We determined the number of PTP- and DP-seroconverters as well as those who could not be classified due to missing testing data. DP-seroconverters had both a documented negative HIV test followed by a positive test during pregnancy or labor/delivery, whereas PTP-seroconverters were diagnosed HIV positive before pregnancy. We calculated the number of MCT among both seroconverter groups. Estimated annual percent change was used to examine trends in the percentages of DP-seroconverters as well as MCT in both seroconverter groups.
Results: Among 10,308 HIV-infected women with live births, 124 (1.2%) were DP-seroconverters, 7,235 (70.2%) were PTP-seroconverters and 2,949 (28.6%) were unclassifiable. A statistically significant 25.0% estimated annual increase in the percent of DP-seroconverters was observed from 2005-2010 (95% CI: 12.3% - 39.1%). MCT occurred among 2.0% of all deliveries; of these, MCT among DP-seroconverters (12.9%) was eight times that among PTP-seroconverters (1.6%)(Z=9.3, p< 0.0001). Non-significant decreases in the percent of MCT were observed in both DP- (p=0.8) and PTP-seroconverters (p=0.1) from 2005-2010.
Conclusions: From 2005-2010, there was a significant increase in the percent of women seroconverting during pregnancy. Efforts for consistent early prenatal HIV testing and repeat third-trimester testing should be enhanced and monitored to assure universal timely provision of MCT prophylaxis.
Back to the Programme-at-a-Glance
.png)
No hay comentarios:
Publicar un comentario