Post on 27-Mar-2015
HIV Positive Mothers and their Infants
Enhanced Perinatal Surveillance and Texas HARS Data
Elvia Ledezma, MPHTexas Department of State Health Services
Objectives
Provide a general overview of perinatal HIV transmission
Give a demographic description of HIV/AIDS infected women delivering in Texas
Present findings on factors influencing perinatal HIV transmission
Offer a summary of findings
Scope of Epidemic in the United States among Women-2005 Women represented 27% of persons living with
HIV/AIDS
127,150 women known to be living with HIV/AIDS 64% are African American women
5,000-7,000 HIV+ women give birth each year This figure represents between 4 to 5 percent of
women living with HIV/AIDS
Scope of Epidemic in the United States among Children-2005 9,078 children diagnosed with AIDS (through 2005)
>90% were perinatally infected
6,109 estimated children perinatally infected and living with HIV/AIDS in 2005 Perinatally infected children account for 1% of all
people living with HIV/AIDS 65% of perinatal infections are among Blacks 141 HIV/AIDS perinatal cases diagnosed in 2005
PACTG
Counseling and Testing
Perinatal HIV/AIDS Infections in Texas, 1999-2005
4.53
3.38
1.78 1.57
5.98
7.87.74
0
50
100
150
200
250
300
350
400
1999 2000 2001 2002 2003 2004 2005
To
tal B
irth
s
0
1
2
3
4
5
6
7
8
9
Pe
rce
nt
Infe
cte
d
Births Infected Children
HIV Positive Women Delivering in Texas 2003-2005
Comparison of Females Living with HIV/AIDS to Women of Childbearing Age Living with HIV/AIDS in Texas, 1999-2005
0
2000
4000
6000
8000
10000
12000
14000
1999 2000 2001 2002 2003 2004 2005
Women of Childbearing Age All Women
Percent of HIV+ Women of Childbearing Age Delivering in Texas, 2003-2005
Did Not Deliver
97%
Delivered3%
HIV+/AIDS Women Delivering and Perinatally Infected Infants, 2003-2005 985 women delivered
70% HIV+ at delivery 30% AIDS diagnosed
1010 live births 23 infected infants 100% HIV diagnosis
Race Distribution Among HIV+ Women Delivering in Texas, 2003-2005
Other/Unk.7%
White12%
Hispanic21%
Black60%
HIV Positive Women Delivering in Texas by Race and Age, 2003-2005
Race/Ethnicity* 15-17 18-24 25-34 35-44
Black 1% 35% 53% 11%
Hispanic 2% 31% 51% 16%
White 1% 31% 49% 19%
Age at Delivery*
*Women of unknown age and race were excluded
Mode of Exposure Among HIV+ Women Delivering in Texas, 2003-2005
Total Number of Pregnancies After HIV Diagnosis Among Women Delivering in Texas, 1999-2005
3 Pregnancies
17
2 Pregnancies
203
1 Pregnancy1066
1.) Diagnosis at least 9 months prior to pregnancy
2.) Women with unknown date of HIV diagnosis were excluded
Total Pregnancies 2,427
Pregnancies After HIV Diagnosis 1, 2
N=1,523
Factors Influencing Perinatal HIV Transmission
Timing and Risk of HIV Transmission in Absence of Interventions During pregnancy 5-10% During labor and delivery 10-20% During breastfeeding 5-20% Overall without breastfeeding 15-30% Overall with breastfeeding until 6 months 25-35% Overall with b.f. until 18-24 months 30-45%
Source: de Cock, JAMA (2000)
Prevention of Perinatal HIV Transmission Receipt of antiretroviral therapy (ART) Receipt of prenatal care Cesarean section Breastfeeding Timing of HIV diagnosis
Prevention of Perinatal HIV Transmission Receipt of antiretroviral therapy (ART) Receipt of prenatal care Cesarean section Breastfeeding Timing of HIV diagnosis
Receipt of ART among HIV+ Women Delivering and Proportion of Infected Children in Texas, 2003-2005
0.0
4.1
1.23
10.4
2.9
0
100
200
300
400
500
600
700
All 3 Timings None Labor/Neon. Neon. Only Other
To
tal W
om
en
0
2
4
6
8
10
12
% o
f C
hild
ren
Infe
cte
d
Births Infected Children
Prevention of Perinatal HIV Transmission Receipt of antiretroviral therapy (ART) Receipt of prenatal care Cesarean section Breastfeeding Timing of HIV diagnosis
Receipt of Prenatal Care among HIV+ Women Delivering and Proportion of Infected Children in Texas, 2003-2005
5.0
1.7
3.5
0
100
200
300
400
500
600
700
None Any Unknown
To
tal W
om
en
0.0
1.0
2.0
3.0
4.0
5.0
6.0
% o
f C
hild
ren
In
fec
ted
Women Infected Children
Trimester of Initiation of Prenatal Care among HIV+ Women Delivering and Proportion of Infected Children in Texas, 2003-2005
3.1
1.3
0.6
7.1
0
50
100
150
200
250
300
350
400
450
500
First Second Third Unknown
To
tal W
om
en
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
% o
f C
hild
ren
Infe
cte
d
Women Infected Children
Kessner Index American College of Obstetrics and Gynecology and the WHO
Criteria Gestational Age Number of Prenatal Care Visits Trimester of Prenatal Care Initiation
Adequacy Categories Adequate Intermediate Inadequate Unknown
Adequacy of Care among HIV+ Women Delivering and Proportion of Infected Children in Texas, 2003-2005
3.1
0.5 0.9
4.5
0
50
100
150
200
250
300
350
Adequate Intermediate Inadequate Unknown
To
tal W
om
en
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0
% o
f C
hild
ren
Infe
cte
d
Women Infected Children
Adequacy of Care and Receipt of 3-Part ART among HIV+ Women Delivering in Texas, 2003-2005
Receipt of 3 Part ART Therapy
Adequacy of Prenatal Care (Kessner Index)
% Yes % No
Adequate 19% 3%
Intermediate 20% 4%
Inadequate 15% 10%
Unknown 13% 17%
Proportion of Infected Children based on Adequacy of Care and Receipt of 3-Part ART among HIV+ Women Delivering in Texas, 2003-2005
0
1.03
2.74
1.61
3.45
0
4.17
7.14
0
1
2
3
4
5
6
7
8
Adequate Intermediate Inadequate Unknown
% o
f Chi
ldre
n In
fect
ed
ART No ART
Prevention of Perinatal HIV Transmission Receipt of antiretroviral therapy (ART) Receipt of prenatal care Cesarean section Breastfeeding Timing of HIV diagnosis
Type of Delivery among HIV+ Women Delivering and Proportion of Infected Children in Texas, 2003-2005
1.8
2.5
1.8
3.6
2.9
0
50
100
150
200
250
300
350
400
450
Vaginal Elective Non-Elect. Ces./Unk.Type
Unk./Miss.
To
tal W
om
en
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
% o
f C
hild
ren
Infe
cte
d
Women Infected Children
Prevention of Perinatal HIV Transmission Receipt of antiretroviral therapy (ART) Receipt of prenatal care Cesarean section Breastfeeding Timing of HIV diagnosis
Breastfeeding Practices among HIV+ Women Delivering and Proportion of Infected Children in Texas, 2003-2005
18.75
1.65
4.08
0
100
200
300
400
500
600
700
800
900
Breast Fed No BF Unk/Miss
To
tal B
irth
s
0
2
4
6
8
10
12
14
16
18
20
% o
f C
hild
ren
Infe
cte
d
Children Infected Children
Prevention of Perinatal HIV Transmission Receipt of antiretroviral therapy (ART) Receipt of prenatal care Cesarean section Breastfeeding Timing of HIV diagnosis
Proportion of Infected Children among HIV+ Women Delivering in Texas based on Timing of Mother’s HIV Diagnosis, 2003-2005
4.53.11
66.7
3.30
100
200
300
400
500
600
700
800
Prior toPregnancy
DuringPregnancy
At Delivery After Delivery Unknown
To
tal W
om
en
0
10
20
30
40
50
60
70
80
% o
f C
hild
ren
In
fec
ted
Women Infected Children
Other Factors Potentially Contributing to Perinatal HIV Infection
Alcohol/Tobacco and Substance Use for HIV+ Women Delivering in Texas, 2003-2005
Indication of alcohol and/or tobacco use (10%, 99)
Indication of substance use (11%, 109) Of the 109 women with an indication of substance use
only 69% received a toxicology screen Only 33% of those with an indication of substance use
were referred for treatment during or after pregnancy
Positive toxicology screen (7%, 69) 68% received inadequate prenatal care Only 46% received 3-Part ART 22% of infected children among women with a positive
toxicology screen
Summary of Findings
Summary of Perinatal Infection in Texas Women delivering in Texas are predominantly Black Proportion of children infected is less among those
diagnosed prior to pregnancy Proportion of children infected is higher among those
receiving Inadequate prenatal care and no antiretroviral therapy.
Proportion of children infected is higher among those that are breastfed.
Prevention measures among women delivering an infected infant For 83% of infected infants-2 or less interventions For 18% of infected infants-3 interventions
Discussion/Comments
Contact Information
Elvia Ledezma, MPH
Epidemiologist
Texas Department of State Health Services
(512)-533-2045
elvia.ledezma@dshs.state.tx.us