Original Article

Missed Opportunities for Preventing Perinatal Transmission of Human Immunodeficiency Virus, Florida, 2007–2014

Authors: Mary Jo Trepka, MD, MSPH, Soumyadeep Mukherjee, MBBS, PhD, Consuelo Beck-Sagué, MD, Lorene M. Maddox, MPH, Kristopher P. Fennie, PhD, MS, Diana M. Sheehan, PhD, MPH, Maithri Prabhakar, MBBS, Dan Thompson, MPH, Spencer Lieb, MPH

Abstract

Objectives: Despite declining numbers of perinatally exposed infants, an increase in perinatal human immunodeficiency virus (HIV) infections from 2011 to 2013 prompted this study to identify missed perinatal HIV prevention opportunities.

Methods: Deidentified records of children born from 2007 through 2014, exposed to HIV perinatally, and reported to the Florida Department of Health were obtained. Crude relative risks (RRs) and 95% confidence intervals (CIs) for factors associated with perinatal transmission, nondiagnosis of maternal HIV infection, and nonreceipt of antiretroviral medication were calculated.

Results: Of the 4337 known singleton births exposed to maternal HIV infection, 70 (1.6%) were perinatally infected. Among perinatal transmission cases, more than one-third of mothers used illegal drugs or acquired a sexually transmitted infection during pregnancy. Perinatal transmission was most strongly associated with maternal HIV diagnosis during labor and delivery (RR 5.66, 95% CI 2.31–13.91) or after birth (RR 26.50, 95% CI 15.44–45.49) compared with antenatally or prenatally. Among the 29 women whose infection was not known before pregnancy and whose child was perinatally infected, 18 were not diagnosed during pregnancy; 12 had evidence of an acute HIV infection, and 6 had no prenatal care.

Conclusions: Late diagnosis of maternal HIV infection appeared to be primarily the result of acute maternal infections and inadequate prenatal care. In Florida, effective programs to improve utilization of prenatal care and detection and primary prevention of prenatal acute infection are needed.

 

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References

1. Lindegren ML, Byers RH, Thomas P, et al. Trends in perinatal transmission of HIV/AIDS in the United States. JAMA 1999;282:531-538.
 
2. Centers for Disease Control and Prevention. Diagnoses of HIV infection in the United States and dependent areas, 2013. HIV Surveillance Report, Volume 25 Published Feb 2015. http://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2013-vol-25.pdf. Accessed December 8, 2016.
 
3. Centers for Disease Control and Prevention. (CDC). Achievements in public health. Reduction in perinatal transmission of HIV infection-United States, 1985-2005. MMWR Morb Mortal Wkly Rep 2006;55:592-597.
 
4. Whitmore SK, Zhang X, Taylor AW, et al. Estimated number of infants born to HIV-infected women in the United States and five dependent areas, 2006. J Acquir Immune Defic Syndr 2011;57:218-222.
 
5. Connor EM, Sperling RS, Gelber R, et al. Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. Pediatric AIDS Clinical Trials Group Protocol 076 Study Group. N Engl J Med 1994;331:1173-1180.
 
6. Drake AL, Wagner A, Richardson B, et al. Incident HIV during pregnancy and postpartum and risk of mother-to-child HIV transmission: a systematic review and meta-analysis. PLoS Med 2014;11:e1001608.
 
7. Townsend CL, Byrne L, Cortina-Borja M, et al. Earlier initiation of ART and further decline in mother-to-child HIV transmission rates, 2000-2011. AIDS 2014;28:1049-1057.
 
8. European Collaborative Study. Mother-to-child transmission of HIV infection in the era of highly active antiretroviral therapy. Clin Infect Dis 2005;40:458-465.
 
9. Florida Department of Health. HIV infection in Florida into the third decade: an historical perspective 1981-2014. http://www.floridahealth.gov/diseases-and-conditions/aids/surveillance/_documents/hiv-aids-slide-sets/2014/year-by-year-1981-2014b.pdf. Revised October 19, 2015. Accessed November 1, 2015.
 
10. Florida Department of State. Rule: 64D-3.029. Diseases or conditions to be reported. https://www.flrules.org/gateway/ruleno.asp?id=64D-3.029&ampSection=0. Accessed November 10, 2015.
 
11. Kotelchuck M. An evaluation of the Kessner Adequacy of Prenatal Care Index and a proposed Adequacy of Prenatal Care Utilization Index. Am J Public Health 1994;84:1414-1420.
 
12. Panel on Treatment of HIV-infected Pregnant Women and Prevention of Perinatal Transmission. Recommendations for use of antiretroviral drugs in pregnant HIV-1-infected women for maternal health and interventions to reduce perinatal HIV transmission in the United States. http://aidsinfo.nih.gov/contentfiles/lvguidelines/PerinatalGL.pdf. Accessed August 26, 2015.
 
13. Harris NS, Fowler MG, Sansom SL, et al. Use of enhanced perinatal human immunodeficiency virus surveillance methods to assess antiretroviral use and perinatal human immunodeficiency virus transmission in the United States, 1999-2001. Am J Obstet Gynecol 2007;197(3 Suppl):S33-S41.
 
14. Whitmore SK, Taylor AW, Espinoza L, et al. Correlates of mother-to-child transmission of HIV in the United States and Puerto Rico. Pediatrics 2012;129:e74-e81.
 
15. Birkhead GS, Pulver WP, Warren BL, et al. Acquiring human immunodeficiency virus during pregnancy and mother-to-child transmission in New York: 2002-2006. Obstet Gynecol 2010;115:1247-1255.
 
16. Gopman S. Prenatal and postpartum care of women with substance use disorders. Obstet Gynecol Clin North Am 2014;41:213-228.
 
17. American College of Obstetricians and Gynecologists Committee on Health Care for Underserved Women. AGOG Committee Opinion no. 473: substance abuse reporting and pregnancy: the role of the obstetrician-gynecologist. Obstet Gynecol 2011;117:200-201.
 
18. Guttmacher Institute. Substance abuse during pregnancy. http://www.guttmacher.org/statecenter/spibs/spib_SADP.pdf. Accessed December 4, 2015.
 
19. Ordean A, Kahan M. Comprehensive treatment program for pregnant substance users in a family medicine clinic. Can Fam Physician 2011;57:e430-435.
 
20. Patterson KB, Leone PA, Fiscus SA, et al. Frequent detection of acute HIV infection in pregnant women. AIDS 2007;21:2303-2308.
 
21. Pilcher CD, Tien HC, Eron JJ, Jr et al. Brief but efficient: acute HIV infection and the sexual transmission of HIV. J Infect Dis 2004;189:1785-1792.
 
22. Garcia PM, Kalish LA, Pitt J, et al. Maternal levels of plasma human immunodeficiency virus type 1 RNA and the risk of perinatal transmission. Women and Infants Transmission Study Group. N Engl J Med 1999;341:394-402.
 
23. Jackson JB, Musoke P, Fleming T, et al. Intrapartum and neonatal single-dose nevirapine compared with zidovudine for prevention of mother-to-child transmission of HIV-1 in Kampala, Uganda: 18-month follow-up of the HIVNET 012 randomised trial. Lancet 2003;362:859-868.
 
24. Taha TE, Kumwenda NI, Gibbons A, et al. Short postexposure prophylaxis in newborn babies to reduce mother-to-child transmission of HIV-1: NVAZ randomised clinical trial. Lancet 2003;362:1171-1177.
 
25. Wade NA, Zielinski MA, Butsashvili M, et al. Decline in perinatal HIV transmission in New York State (1997-2000). J Acquir Immune Defic Syndr 2004;36:1075-1082.
 
26. Committee on Health Policy. Review of the Florida statutes relating to HIV testing. http://archive.flsenate.gov/data/Publications/2008/Senate/reports/interim_reports/pdf/2008-134hp.pdf. Published October 2007. Accessed November 10, 2015.
 
27. Centers for Disease Control and Prevention. Laboratory testing for the diagnosis of HIV infection: updated recommendations. http://stacks.cdc.gov/view/cdc/23447. Published June 27, 2014. Accessed March 7, 2016.
 
28. Kharsany AB, Hancock N, Frohlich JA, et al. Screening for “window-period” acute HIV infection among pregnant women in rural South Africa. HIV Med 2010;11:661-665.
 
29. Committee opinion no: 635: prenatal and perinatal human immunodeficiency virus testing: expanded recommendations. Obstet Gynecol 2015;125:1544-1547.
 
30. Branson BM, Handsfield HH, Lampe MA, et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm. Published September 12, 2006. Accessed March 10, 2016.
 
31. Devieux JG, Jean-Gilles M, Rosenberg R, et al. Depression, abuse, relationship power and condom use by pregnant and postpartum women with substance abuse history. AIDS Behav 2016;20:292-303.