Prevention of Perinatal HIV Transmission in an Area of High HIV Prevalence in the United States.

MedStar author(s):
Citation: Journal of Pediatrics. 228:101-109, 2021 01.PMID: 32971142Institution: MedStar Health Research InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *DNA, Viral/an [Analysis] | *HIV Infections/pc [Prevention & Control] | *HIV/ge [Genetics] | *Infectious Disease Transmission, Vertical/pc [Prevention & Control] | *Postpartum Period | *Pregnancy Complications, Infectious/ep [Epidemiology] | Adult | Female | HIV Infections/ep [Epidemiology] | Humans | Infant, Newborn | Male | Pregnancy | Prevalence | Prognosis | Retrospective Studies | United States/ep [Epidemiology] | Young AdultYear: 2021Local holdings: Available online from MWHC library: 1995 - presentISSN:
  • 0022-3476
Name of journal: The Journal of pediatricsAbstract: CONCLUSION: In an area of high HIV prevalence in the US, a large proportion of low-risk HIV-exposed infants received intrapartum zidovudine and was delivered via cesarean delivery. We also observed missed opportunities for the prevention of perinatal HIV transmission. Copyright (c) 2020 Elsevier Inc. All rights reserved.OBJECTIVE: To evaluate the uptake of perinatal HIV preventive interventions by risk of perinatal HIV transmission in mother-infant pairs in a high HIV prevalence area in the United States (US).RESULTS: We analyzed 551 HIV-exposed infants and 542 mothers living with HIV. The majority of mothers received ARVs (95.5%), had HIV RNA <=1,000 copies/mL before delivery (81.9%), and received intrapartum zidovudine (65.5%). The majority of all HIV-exposed infants was low-risk (82.6%) and received postpartum ARVs (98.9%). Among low-risk infants, 53.2% were delivered via cesarean delivery, and 62.9% and 96.5% were administered intrapartum and postpartum zidovudine, respectively. Among high-risk infants, 84.4% were delivered via cesarean delivery, 78.1% received intrapartum zidovudine, and 62.5% received combination ARVs. Nine high-risk infants acquired HIV perinatally.STUDY DESIGN: This was a retrospective cohort study of mother-infant pairs with perinatal HIV exposure during 2013-2017 managed at a subspecialty pediatric HIV program in Washington, DC. We collected demographics, maternal HIV history, delivery mode, maternal and infant antiretroviral drug (ARV) use, and infant's HIV test results. We compared the uptake of recommended preventive interventions in low-risk (mothers on ARVs with viral suppression) and high-risk (mothers without ARVs or viral suppression) mother-infant pairs using Pearson Chi-square, Fisher exact, Wilcoxon rank sum tests, and logistic regression.All authors: Castel AD, Ferrer KT, Griffith CJ, Koay WLA, Manepalli KV, Rakhmanina NY, Scott RK, Zhang JOriginally published: Journal of Pediatrics. 2020 Sep 21Fiscal year: FY2021Digital Object Identifier: Date added to catalog: 2020-10-06
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 32971142 Available 32971142

Available online from MWHC library: 1995 - present

CONCLUSION: In an area of high HIV prevalence in the US, a large proportion of low-risk HIV-exposed infants received intrapartum zidovudine and was delivered via cesarean delivery. We also observed missed opportunities for the prevention of perinatal HIV transmission. Copyright (c) 2020 Elsevier Inc. All rights reserved.

OBJECTIVE: To evaluate the uptake of perinatal HIV preventive interventions by risk of perinatal HIV transmission in mother-infant pairs in a high HIV prevalence area in the United States (US).

RESULTS: We analyzed 551 HIV-exposed infants and 542 mothers living with HIV. The majority of mothers received ARVs (95.5%), had HIV RNA <=1,000 copies/mL before delivery (81.9%), and received intrapartum zidovudine (65.5%). The majority of all HIV-exposed infants was low-risk (82.6%) and received postpartum ARVs (98.9%). Among low-risk infants, 53.2% were delivered via cesarean delivery, and 62.9% and 96.5% were administered intrapartum and postpartum zidovudine, respectively. Among high-risk infants, 84.4% were delivered via cesarean delivery, 78.1% received intrapartum zidovudine, and 62.5% received combination ARVs. Nine high-risk infants acquired HIV perinatally.

STUDY DESIGN: This was a retrospective cohort study of mother-infant pairs with perinatal HIV exposure during 2013-2017 managed at a subspecialty pediatric HIV program in Washington, DC. We collected demographics, maternal HIV history, delivery mode, maternal and infant antiretroviral drug (ARV) use, and infant's HIV test results. We compared the uptake of recommended preventive interventions in low-risk (mothers on ARVs with viral suppression) and high-risk (mothers without ARVs or viral suppression) mother-infant pairs using Pearson Chi-square, Fisher exact, Wilcoxon rank sum tests, and logistic regression.

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