HIV Positive Mothers and their Infants Enhanced Perinatal Surveillance and Texas HARS Data Elvia...

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

Jorge J. Reyes

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

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

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


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


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

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


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

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


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

[email protected]

HIV Positive Mothers and their Infants Enhanced Perinatal Surveillance and Texas HARS Data Elvia...

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