1. HIV Positive Mothers and their Infants Enhanced Perinatal Surveillance and Texas HARS Data Elvia Ledezma, MPH Texas Department of State Health Services

2. 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

3. 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

4. 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

5. PACTG Counseling and Testing

6. Perinatal HIV/AIDS Infections in Texas, 1999-2005

7. HIV Positive Women Delivering in Texas 2003-2005

8. Comparison of Females Living with HIV/AIDS to Women of Childbearing Age Living with HIV/AIDS in Texas, 1999-2005

9. Percent of HIV+ Women of Childbearing Age Delivering in Texas, 2003-2005

10. 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

11. Race Distribution Among HIV+ Women Delivering in Texas, 2003-2005

12. HIV Positive Women Delivering in Texas by Race and Age, 2003-2005 Race/Ethnicity*15-1718-2425-3435-44 Black1%35%53%11% Hispanic2%31%51%16% White1%31%49%19% Age at Delivery* * Women of unknown age and race were excluded

13. Mode of Exposure Among HIV+ Women Delivering in Texas, 2003-2005

14. Total Number of Pregnancies After HIV Diagnosis Among Women Delivering in Texas, 1999-2005 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

15. Factors Influencing Perinatal HIV Transmission

16. 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)

17. Prevention of Perinatal HIV Transmission Receipt of antiretroviral therapy (ART) Receipt of prenatal care Cesarean section Breastfeeding Timing of HIV diagnosis

18. Prevention of Perinatal HIV Transmission Receipt of antiretroviral therapy (ART) Receipt of prenatal care Cesarean section Breastfeeding Timing of HIV diagnosis

19. Receipt of ART among HIV+ Women Delivering and Proportion of Infected Children in Texas, 2003-2005

20. Prevention of Perinatal HIV Transmission Receipt of antiretroviral therapy (ART) Receipt of prenatal care Cesarean section Breastfeeding Timing of HIV diagnosis

21. Receipt of Prenatal Care among HIV+ Women Delivering and Proportion of Infected Children in Texas, 2003-2005

22. Trimester of Initiation of Prenatal Care among HIV+ Women Delivering and Proportion of Infected Children in Texas, 2003-2005

23. 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

24. Adequacy of Care among HIV+ Women Delivering and Proportion of Infected Children in Texas, 2003-2005

25. 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 Adequate19%3% Intermediate20%4% Inadequate15%10% Unknown13%17%

26. Proportion of Infected Children based on Adequacy of Care and Receipt of 3-Part ART among HIV+ Women Delivering in Texas, 2003-2005

27. Prevention of Perinatal HIV Transmission Receipt of antiretroviral therapy (ART) Receipt of prenatal care Cesarean section Breastfeeding Timing of HIV diagnosis

28. Type of Delivery among HIV+ Women Delivering and Proportion of Infected Children in Texas, 2003-2005

29. Prevention of Perinatal HIV Transmission Receipt of antiretroviral therapy (ART) Receipt of prenatal care Cesarean section Breastfeeding Timing of HIV diagnosis

30. Breastfeeding Practices among HIV+ Women Delivering and Proportion of Infected Children in Texas, 2003-2005

31. Prevention of Perinatal HIV Transmission Receipt of antiretroviral therapy (ART) Receipt of prenatal care Cesarean section Breastfeeding Timing of HIV diagnosis

32. Proportion of Infected Children among HIV+ Women Delivering in Texas based on Timing of Mothers HIV Diagnosis, 2003-2005

33. Other Factors Potentially Contributing to Perinatal HIV Infection

34. 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

35. Summary of Findings

36. 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

37. Discussion/Comments

38. Contact Information Elvia Ledezma, MPH Epidemiologist Texas Department of State Health Services (512)-533-2045 elvia.ledezma@dshs.state.tx.us