Over half of infants diagnosed with HIV did not receive preventive treatment

Key takeaways:

• Among over 3 million infants born from 2009 to 2021, 0.07% received postnatal antiretroviral prophylaxis.
• Of infants with an HIV diagnosis in the first year of life, 51.9% did not receive perinatal prophylaxis.

A significant number of Medicaid-insured infants infected with HIV in the first year of their life did not receive postnatal antiretroviral prophylaxis, a study presented at IDWeek showed.

HIV can have significant implications for the long-term health of children aged younger than 5 years, who have a death rate of two to nine times higher vs. other age groups among those treated for the chronic disease.

Mingyue Lu, a PhD student in health policy and administration at the University of Chicago Illinois School of Public Health, explained during a press briefing that there have previously been no large-scale studies reporting on postnatal antiretroviral prophylaxis trends in the United States “to provide information that can impact policies.”

In the analysis, Lu and Kengo Inagaki, MD, a clinical associate professor at the University of Michigan, examined data from the MarketScan Multi-State Medicaid Database from 2009 to 2021.

“[W]e identified antiretroviral use among infants and classified them into single, double and triple drug prophylactic and therapeutic use,” Lu said. “In parallel, we evaluated the number of new infections and categorized them in terms of demographics and prophylactic regime.”

The analysis showed a total of 3,147,318 newborn infants born from 2009 to 2021.

Among the infants, 2,304 — or 0.07% — received postnatal antiretroviral prophylaxis, with 2,123 receiving zidovudine single prophylaxis in 2009.

Lu and Inagaki noted that the rate of infants receiving zidovudine single prophylaxis dropped to 71.7% by 2021 due to the adoption of double and triple prophylactic regimens, whereas triple prophylaxis became more frequently used vs. double prophylaxis by 2018.

The researchers found 52 infants diagnosed with HIV within the first year of life, among whom 51.9% did not receive perinatal prophylaxis, “suggesting missed maternal infections,” Lu said.

“Increased access to prenatal care to promote HIV screening and treatment programs in all populations, including minoritized populations, must be improved,” Lu added.

There have been no definitive studies “to support the superiority of triple drug antiretroviral prophylaxis regimens to double drug antiretroviral prophylaxis” for the prevention of HIV transmission, Lu continued.

Ultimately, the findings can help “guide future research and interventions by identifying future populations most at risk [for] missed maternal diagnoses and prenatal transmission,” Lu concluded. “Public health research can now explore more effective outreach, education and support programs for pregnant women in vulnerable populations, especially Black women, as well as more effective use of antiretroviral prophylaxis.”

References:

• Lu M, Inagaki K. Abstract 164. Presented at: IDWeek, Oct. 16-19, 2024; Los Angeles.
• More than half of Medicaid-insured infants born with HIV had no preventative treatment. Available at: https://www.idsociety.org/news--publications-new/articles/2024/more-than-half-of-medicaid-insured-infants-born-with-hiv-had-no-preventative-treatment. Published Oct. 16, 2024. Accessed Oct. 16, 2024.