HIV Positive Mothers and their Infants Enhanced Perinatal Surveillance and Texas HARS Data Elvia Ledezma, MPH Texas 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 ,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,

HIV Positive Women Delivering in Texas

Comparison of Females Living with HIV/AIDS to Women of Childbearing Age Living with HIV/AIDS in Texas,

Percent of HIV+ Women of Childbearing Age Delivering in Texas,

HIV+/AIDS Women Delivering and Perinatally Infected Infants, 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,

HIV Positive Women Delivering in Texas by Race and Age, Race/Ethnicity* Black1%35%53%11% Hispanic2%31%51%16% White1%31%49%19% Age at Delivery* * Women of unknown age and race were excluded

Mode of Exposure Among HIV+ Women Delivering in Texas,

Total Number of Pregnancies After HIV Diagnosis Among Women Delivering in Texas, ) 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 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,

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,

Trimester of Initiation of Prenatal Care among HIV+ Women Delivering and Proportion of Infected Children in Texas,

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,

Adequacy of Care and Receipt of 3-Part ART among HIV+ Women Delivering in Texas, Receipt of 3 Part ART Therapy Adequacy of Prenatal Care (Kessner Index) % Yes% No Adequate19%3% Intermediate20%4% Inadequate15%10% Unknown13%17%

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

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,

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,

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 Mothers HIV Diagnosis,

Other Factors Potentially Contributing to Perinatal HIV Infection

Alcohol/Tobacco and Substance Use for HIV+ Women Delivering in Texas, 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)