As of September 30, 1996, a total of 566,002 acquired
immunodeficiency syndrome (AIDS) cases, including 7472 cases
among children aged less than 13 years (1%), had been reported to
CDC by state and territorial health departments. Most children
reported with AIDS acquired human immunodeficiency virus (HIV)
infection perinatally from their mothers (1). During 1988-1993,
an estimated 6000-7000 children were born each year to
HIV-infected women; an estimated 1000-2000 of these children were
infected annually (2). In 1994, results of clinical trials
demonstrating effective therapy for reducing perinatal HIV
transmission indicated a two-thirds decrease in such transmission
associated with zidovudine (ZDV) therapy for HIV-infected
pregnant women and their newborns. The Public Health Service
(PHS) issued recommendations in 1994 for ZDV treatment to reduce
perinatal HIV transmission, and in 1995 for routine HIV
counseling and voluntary testing for all pregnant women in the
United States (3,4). This report summarizes the epidemiology
of AIDS in children in the United States reported cumulatively
from 1982 through September 1996, presents rates for 1995 (the
most recent year for which census estimates are available), and
describes a recent decrease in the rate of perinatally acquired
AIDS Among Children
Of the 7472 children reported with AIDS, 58% were
non-Hispanic black, 23% were Hispanic, 18% were non-Hispanic
white, and 1% were of other racial/ethnic groups. During 1995,
the rates of reported AIDS cases per 100,000 children were 6.4
for non-Hispanic blacks, 2.3 for Hispanics, 0.4 for non-Hispanic
whites, 0.4 for American Indians/Alaskan Natives, and 0.3 for
Asians/Pacific Islanders. Among all U.S. children with AIDS,
6750 (90%) acquired HIV perinatally, 370 (5%) through receipt of
contaminated blood transfusions, and 231 (3%) through receipt of
contaminated blood products for coagulation disorders; 121 (2%)
had no reported risk factor. Among children with perinatally
acquired AIDS, the median age at diagnosis was 18 months.
Approximately 80% of all children with AIDS had AIDS diagnosed
before age 5 years. The highest numbers of cases were reported
from New York (1901), Florida (1199), New Jersey (661),
California (524), Puerto Rico (347), and Texas (296); combined,
these cases accounted for 66% of all AIDS cases reported among
Risk exposures for HIV infection among the mothers of the
6750 children with perinatally acquired AIDS included
injecting-drug use (IDU) (41%), sexual contact with a partner
with or at risk for HIV/AIDS (34%), and receipt of contaminated
blood or blood products (2%); for 13%, no risk was specified.
Trends in Perinatally Acquired AIDS
To examine trends in the incidence of AIDS among children
born to HIV-infected mothers, the number of perinatally acquired
AIDS cases diagnosed each quarter from 1986 through March 1996
was estimated using standard statistical adjustments that account
for delays in reporting cases to CDC and estimates of behavioral
risk among persons reported without a risk (1). The estimated
number of children with perinatally acquired AIDS peaked at 905
during 1992, followed by a decline in incidence.
From 1992 through 1995, the estimated annual number of
perinatally acquired AIDS cases declined 27%, from 905 to 663.
During this time, the estimated annual number of cases declined
39% among non-Hispanic white, 26% among non-Hispanic black, and
25% among Hispanic children. The proportionate decrease in the
number of children with perinatally acquired AIDS from the six
areas reporting the highest number of cases was greater than the
decrease for all remaining areas and for all areas combined.
HIV Infection Among Children
To enhance the usefulness of surveillance systems to
characterize affected populations and to improve the targeting of
resources for prevention and care, 28 states require confidential
reporting of children with HIV infection without a diagnosis of
AIDS as well as those with AIDS (1). Through September 1996,
these states reported 29% (2155) of all children with AIDS and
1447 children with HIV infection. During 1995, these states
reported 228 AIDS cases among children and 302 children with
documented HIV infection who had not developed AIDS.
During 1995, these states received 1464 additional reports of
children who were born to HIV-infected mothers but who require
follow-up with providers to determine their HIV-infection status.
Among the six reporting areas with the highest cumulative number
of children with AIDS, only New Jersey and Texas require reports
of HIV infection among children.
Reported by state, territorial, and local health departments. Div
of HIV/AIDS Prevention, National Center for HIV, STD, and TB
The findings in this report document a decline in
the incidence of perinatally acquired AIDS before and after the
release of PHS recommendations for HIV counseling and voluntary
testing for pregnant women and for ZDV therapy to prevent
perinatal transmission (3,4). The recommendations were issued to
promote the adoption of these HIV-prevention strategies as
standard medical practice in the United States. Because the
number of HIV-infected women who gave birth each year was stable
during 1989-1994 (5), this decline suggests that the decrease in
perinatal HIV transmission
rates probably reflected the effect of
perinatal ZDV therapy. Increasing proportions of women may be
accepting voluntary prenatal HIV testing
and using ZDV to prevent
perinatal transmission (6,7).
Because the incidence of perinatally acquired AIDS declined
slightly before the PHS recommendations on ZDV therapy were
issued in 1994, other factors may have contributed to the
decrease in perinatally acquired AIDS cases during this period.
For example, the proportion of HIV-infected childbearing women
who received ZDV therapy before and during pregnancy for
treatment of their HIV disease was increasing (8). Among
children, increased use of prophylaxis to prevent AIDS
opportunistic infections may have delayed the development of
these conditions. However, the incidence of Pneumocystis carinii
pneumonia, the most common AIDS-defining condition among
children, has not decreased substantially among young children
AIDS surveillance conducted in all reporting areas provides
a standardized means to monitor AIDS incidence in children as a
measure of the effectiveness of perinatal prevention efforts. To
further characterize implementation of counseling, testing, and
treatment for HIV-infected mothers and their children, CDC and
other federal agencies are initiating facility-based program
evaluations in selected high-incidence areas. These studies also
will examine factors that may contribute to a change in perinatal
HIV transmission rates (e.g., changing obstetrical practices and
womens' attitudes toward and adherence to ZDV and other
preventive therapy). In states that conduct confidential HIV
reporting for children, timely assessment of HIV-prevention
measures in mother-infant pairs (e.g., prenatal care and prenatal
and neonatal ZDV therapy) will measure changes in perinatal HIV
transmission rates statewide and permit refinement and
redirection of prevention efforts. The Council of State and
Territorial Epidemiologists has recommended that all
states implement HIV infection reporting for children and
consider reporting of all children of indeterminate HIV status
who were born to infected mothers.
In the United States, HIV and AIDS disproportionately affect
non-Hispanic black and Hispanic women and their children. This
disparity probably reflects socioeconomic factors, access to and
use of medical services, or differences in behaviors associated
with HIV transmission risks among women. Health-care providers in
the public and private sectors should implement comprehensive
integrated-service delivery programs to ensure that all women
have access to HIV counseling and voluntary testing and to
services for related health needs (e.g., antiretroviral therapy,
substance-abuse treatment, and social and support services).
The ZDV regimen recommended in the United States is not an
affordable prevention strategy in many countries where HIV
prevalence rates among women are highest. Worldwide, an estimated
8.8 million women and 800,000 children have HIV/AIDS; most of
these persons reside in sub-Saharan Africa where resources for
health services infrastructure are limited (World Health
Organization, unpublished data, 1996). CDC and other
organizations are collaborating with ministries of health in
Africa and Asia to evaluate the effectiveness of shorter and
simplified ZDV regimens, other antiretroviral medications, and
other interventions for reducing perinatal HIV transmission.
However, because ZDV treatment or other potential interventions
are not universally effective in preventing perinatal
transmission, primary prevention of HIV infection among children
will continue to require preventing new HIV infections among
women in the United States and other countries.
- CDC. HIV/AIDS surveillance report. Atlanta: US Department of
Health and Human Services, Public Health Service, 1996:3-4, 30-3.
(Vol 8, no. 1).
- Davis SF, Byers RH, Jr, Lindegren ML, Caldwell MB, Karon JM,
Gwinn M. Prevalence and incidence of vertically acquired HIV
infection in the United States. JAMA 1995;274:952-5.
- CDC. Recommendations of the U.S. Public Health Service Task
Force on the use of zidovudine to reduce perinatal transmission
of human immunodeficiency virus. MMWR 1994;43(no. RR-11).
- CDC. U.S. Public Health Service recommendations for human
immunodeficiency virus counseling and voluntary testing for
pregnant women. MMWR 1995;44(no. RR-7).
- Davis SF, Steinberg S, Jean-Simon M, Rosen D, Gwinn M. HIV
prevalence among U.S. childbearing women, 1989-1994 [Abstract].
Vancouver, British Columbia: XI International Conference on AIDS,
- Lindsay MK, Peterson HB, Feng TI, Slade BA, Willis S, Klein L.
Routine antepartum human immunodeficiency virus infection
screening in an inner-city population. Obstet Gynecol
- Thomas P, Singh T, Lindegren ML, Saletan S, Brooks A, Forlenza
S. Patterns of zidovudine (ZDV) use in pregnant HIV-infected
women in New York City (NYC) [Abstract]. Vancouver, British
Columbia: XI International Conference on AIDS, 1996.
- Simonds RJ, Nesheim S, Matheson P, et al. Declining
mother-to-child HIV transmission following perinatal zidovudine
recommendations, United States [Abstract]. Vancouver, British
Columbia: XI International Conference on AIDS, 1996.
- Lindegren ML, Byers R, Fleming P, et al. A decline in the
incidence of perinatally acquired (PA) AIDS in the United States
[Abstract]. Vancouver, British Columbia: XI International
Conference on AIDS, 1996.
- CDC. 1995 Revised guidelines for prophylaxis against
Pneumocystis carinii pneumonia for children infected with or
perinatally exposed to human immunodeficiency virus. MMWR
* Single copies of this report will be available until November
22, 1997, from the CDC National AIDS Clearinghouse, P.O. Box
6003, Rockville, MD 20849-6003; telephone (800) 458-5231 or (301)