Vertical HIV Transmission Rate Down in U.S.

Although the percentage of HIV-positive women who give birth to HIV-positive infants has declined "dramatically" in developed nations due largely to the use of antiretroviral drugs, a lack of prenatal care increases a woman's likelihood that she will transmit the virus to her infant, according to a study published in the Jan. 2 issue of the CDC's Morbidity and Mortality Weekly Report, Reuters Health reports.

Researchers from the CDC assessed compliance with the U.S. Public Health Service guidelines recommending universal prenatal HIV counseling, voluntary HIV testing and provision of antiretroviral drugs to HIV-positive pregnant women and their newborns at Grady Memorial Hospital in Atlanta between 1997 and 2000.

Of the 253 infants born to HIV-positive women at the hospital during the time period, 17 were HIV-positive, according to the researchers. Between 1999 and 2000, nine HIV-positive infants were born at Grady Memorial. Of those infants, six were born to women who did not receive any prenatal care and three were born to women who received some prenatal care but for whom the antiretroviral drug regimen or timing was not optimal. During the same time period, no cases of vertical transmission were identified among HIV-positive women who received adequate prenatal counseling, HIV testing and antiretroviral drugs. During the four-year study period, the vertical HIV transmission rate ranged from 3% to 10% (Reuters Health, 12/31/03).

Before the introduction of antiretroviral drugs, approximately 25% of all infants born to HIV-positive women were born infected, according to Dr. Mary Glenn Fowler, who oversees CDC's perinatal HIV research.

Focus on Prenatal Care, Drug Regimen Adherence

Fowler said, "We know that if we get women into prenatal care, get them properly tested and start them early on antiretrovirals, we can reduce the [vertical HIV] transmission rate to about 2%," adding, "This study shows the failures, those who slipped through, and the numbers are reflective of what we see nationally" (Guthrie, Atlanta Journal-Constitution, 1/2).

The CDC researchers concluded, "For pregnant women who receive prenatal care and know their HIV status, prevention programs should focus on promoting adherence to recommended treatment regimens and administering (AIDS drugs) during pregnancy. Efforts to reduce (mother-to-infant) HIV transmission should continue to focus on increasing prenatal care rates and prenatal HIV testing, particularly in areas where missed opportunities for prevention of perinatal HIV transmission persist" (Reuters Health, 12/31/03).

Reprinted with permission from kaisernetwork.org (www.kaisernetwork.org). You can view the entire Kaiser Daily Reproductive Health Report. Search the archives at www.kaisernetwork.org/dailyreports/repro and sign up for email delivery at www.kaisernetwork.org/dailyreports/repro. The Kaiser Daily Reproductive Health Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. ? 2004 Advisory Board Company and Kaiser Family Foundation. All rights reserved.