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More focus needed on perinatal HIV prevention

The estimated number of childbearing-age women with HIV increased by 30% between 2000 and 2006, according to new study results.

The results suggested that prevention of mother-to-child transmission of HIV needs more attention and that such prevention efforts in hard-to-reach populations will likely require additional effort and expense per case than needed previously.

However, given the estimated discounted lifetime cost of $250,000 for medical care for a child with HIV, the financial benefit of further reductions in mother-to-child transmissions is evident. A reduction in mother-to-child transmission rates to less than 1% can be achieved among women whose HIV viral load becomes undetectable because of highly active antiretroviral therapy. In fact, the estimated number of new perinatal HIV infections in the United States peaked at approximately 1,760 cases in 1991 but dropped by more than 90% following recommendations for routine prenatal HIV testing and antiretroviral prophylaxis of all pregnant HIV-infected women.

Efforts to eliminate perinatal HIV transmission will require four things: 1) ongoing and increased emphasis on family planning and preconception care for women with HIV; 2) comprehensive case identification; 3) coordinated case finding, management and review; and 4) local action based on the concept that perinatal transmission is a sentinel event, according to the study’s researchers.

Possible causes for ongoing cases include acute HIV infection during pregnancy and antiretroviral resistance and missed opportunities to prevent mother-to-child transmission, although the portion of new perinatal HIV infections attributable to these causes is yet to be determined.

In addition, providing optimal preventive interventions to a hard-to-reach small percentage of HIV-infected women will continue to pose a significant challenge, according to the study results.

For more information:

• Nesheim S. #C16-4. Presented at: 2009 National HIV Prevention Conference; Aug. 23-26, 2009; Atlanta.