Estimated number of perinatal HIV infections, U.S., 2000
Background: Perinatal HIV transmission decreased due to voluntary testing of pregnant women, ZDV use and HAART. We estimated the number of HIV+ infants born in the U.S. in 2000 from surveillance data, chart reviews and special projects.
Methods: A Poisson regression model estimated prevalent diagnosed (dx'd) HIV cases from reported AIDS cases in 25 states with HIV and AIDS data. Predicted HIV cases were compared to observed; best fit model was applied to AIDS data to estimate women 13-44, alive, dx'd with HIV (not AIDS). AIDS prevalence in women was estimated from AIDS cases and deaths. Births were estimated for women alive with HIV (not AIDS), CD4<200 AIDS, and clinical AIDS. Proportions on HAART vs ZDV only were from data on mother-infant pairs in 7 states in 1999. Observed transmission rates (TMR) from mothers in 32 states who were dx'd before or at birth and a 25% TMR for those dx'd after birth were used to estimate the number of HIV+ infants.
Results: 49,238 women were living with AIDS (CD4<200: 46%, 3.2 births/100PY; clinical:54%, 2.0 births/100PY); 80,293-86,080 women were living with HIV (not AIDS) and had 6.0 births/100PY. Total births: 6,075-6,422. 89% of mothers were dx'd before, 5% at, 6% after birth. Applying a 2% TMR to 60% of mothers dx'd before birth who had HAART, a 6% TMR to 40% of mothers who had ZDV only, yields 195-206 births. For 5% dx'd at birth, a 10% TMR yields 30-32 births. For 6% dx'd after birth, a 25% TMR yields 91-96 births. HIV+ births in 2000 were 284-367(likely range: 280-370); this is down 79-84% from the 1991 peak of HIV+ births observed in survey data.
Conclusions: Perinatal HIV infections declined >80% in the 1990's. Eliminating perinatal HIV infections will be difficult due to a growing number of HIV+ women and less than 100% effective interventions. To further reduce HIV+ births: prevent HIV in women; provide timely prenatal care, testing; develop more effective treatments; promote adherence.
The XIV International AIDS Conference
" P L Fleming, et al.
Estimated number of perinatal HIV infections, U.S., 2000.
The XIV International AIDS Conference: