Reduced yet persistent incidence of vertical HIV transmission in the United States

1. Overall incidence of vertical HIV transmission in the United States decreased from 2002 to 2013, and currently is at an estimated 1.75 per 100,000 live births.

2. The use of appropriate recommended antiretroviral (ARV) therapy for prevention of infection was low amongst newly infected infant-mother pairs, suggesting that lack of prenatal care and ARV therapy were responsible for the persistent vertical transmission.

Evidence Rating Level: 2 (Good)       

Study Rundown: Screening programs to identify HIV-infected mothers and institute antiretroviral (ARV) therapy prenatally, at time of labor and delivery, and postnatally, are aimed at reducing vertical transmission of HIV. The Center for Disease Control (CDC) has stated a goal rate of 1 vertical transmission per 100,000 live births. This study analyzed rates of vertical HIV transmission in the US from 2002 to 2013.

The study demonstrated a reduction in vertical transmission of HIV infection from 2002 to 2013, however the rate in 2013 still exceeded the CDC target rate. Perinatal infection was more common in African American mothers, and ARV prophylaxis occurred in only a quarter of cases. Mothers who underwent at least one prenatal care visit were more likely to receive ARV prophylaxis. Geographic location was also an important factor, with 5 southern states accounting for 38% of cases. The study was comprehensive in data collection of perinatal HIV infection with a long reporting period. However, significant data gaps were present in important factors, such as degree of perinatal care, type of prophylaxis used, viral loads at time of labor, comorbid conditions such as substance use, and mental health, which reduced the study’s ability to identify barriers to further reducing the rates of vertical transmission.

Click to read the study, published in JAMA Pediatrics

Relevant Reading: No Perinatal HIV-1 Transmission From Women With Effective Antiretroviral Therapy Starting Before Conception

In-Depth [retrospective cohort]: This study used data from the National HIV Surveillance System of the CDC for births between 2002 to 2013, with follow up to 2015, to evaluate the incidence of vertical transmission of HIV. Variables examined included ethnicity, prenatal care visits, timing of maternal HIV diagnosis, ARV therapy and prophylaxis, breastfeeding status, and mode of delivery. Data were missing for certain variables in up to 48.9% of cases.

Rates of perinatal infection decreased from 5.37- to 1.75- per 100 000 live births from 2002 to 2013. Five southern states (Florida, Texas, Georgia, Louisiana, and Maryland) accounted for 38% of total cases. A total of 63% of mothers were black or African-American, while 18.3% were Hispanic, and 13.9% were white. Diagnosis of HIV occurred before pregnancy in 41.8% of cases. ARV prophylaxis at prenatal, perinatal, and postnatal time points occurred in 25.4% of cases.

Image: PD

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