THAC0104 - Oral Abstract Session
HIV seroconversion during pregnancy and mother-to-child HIV transmission: data from the Enhanced Perinatal Surveillance Project, United States, 2005-2010
Presented by Sonia Singh (United States).
S. Singh1, M.A. Lampe1, A. Surendera Babu2, S. Rao1, C.B. Borkowf1, S.R. Nesheim1
1Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, United States, 2ICF International, Atlanta, United States
Background: In the United States (US), HIV screening is recommended for all pregnant women. Repeat screening is recommended in jurisdictions with elevated rates of HIV and for women with known HIV risk. This study examined the numbers of women seroconverting prior to pregnancy (PTP) and during pregnancy (DP) and the associated mother-to-child HIV transmission (MCT).
Methods: Data from HIV-infected women who delivered live infants from 2005-2010 in 15 US areas that conduct the Centers for Disease Control and Prevention's Enhanced Perinatal Surveillance (EPS) were used. EPS data were linked with National HIV Surveillance data reported through June 2011 to replace missing test dates. We determined the number of PTP- and DP-seroconverters as well as those who could not be classified due to missing testing data. DP-seroconverters had both a documented negative HIV test followed by a positive test during pregnancy or labor/delivery, whereas PTP-seroconverters were diagnosed HIV positive before pregnancy. We calculated the number of MCT among both seroconverter groups. Estimated annual percent change was used to examine trends in the percentages of DP-seroconverters as well as MCT in both seroconverter groups.
Results: Among 10,308 HIV-infected women with live births, 124 (1.2%) were DP-seroconverters, 7,235 (70.2%) were PTP-seroconverters and 2,949 (28.6%) were unclassifiable. A statistically significant 25.0% estimated annual increase in the percent of DP-seroconverters was observed from 2005-2010 (95% CI: 12.3% - 39.1%). MCT occurred among 2.0% of all deliveries; of these, MCT among DP-seroconverters (12.9%) was eight times that among PTP-seroconverters (1.6%)(Z=9.3, p< 0.0001). Non-significant decreases in the percent of MCT were observed in both DP- (p=0.8) and PTP-seroconverters (p=0.1) from 2005-2010.
Conclusions: From 2005-2010, there was a significant increase in the percent of women seroconverting during pregnancy. Efforts for consistent early prenatal HIV testing and repeat third-trimester testing should be enhanced and monitored to assure universal timely provision of MCT prophylaxis.
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