Drop in perinatal transmission only HIV success. (Expert Opinion).

KEY LARGO, FLA. -- The good news regarding HIV infection in the United States is that the risk of perinatal transmission is now less than 2%.

The bad news is that over Americans are becoming complacent about HIV and AIDS, Dr. May J. O'Sullivan said at an ob.gyn. update sponsored by the University of Miami.

"The perinatal transmission rate is the only major success of therapy," said Dr. O'Sullivan, an attending physician in the department of obstetrics and gynecology at the University of Miami/Jackson Memorial Medical Center.

There were 224 known cases of perinatal transmission in the United States in 2002, a 75% decrease, compared with the peak of 905 cases in 1992. This lower incidence is attributed to chemoprophylaxis highly active antiretroviral therapy (HAART), and cesarean sections.

The highest rates of HIV infection in pregnant women are in New York City with 5.8 cases/1,000 pregnancies. In Washington, D.C., the incidence is 5.5/1,000, followed by 4.9 in New Jersey, and 4.5 in Florida. These rates reflect the overall geographic prevalence of HIV infection in the United States. "The Northeast and Southern parts of the United States rank extremely high in AIDS cases," she said.

Ob.gyns. and pediatricians may encounter an increasing number of patients with HIV infection. Overall, women account for 23% of new cases of HIV infection, versus only 7% in 1985. In addition, Dr. O'Sullivan said, "In the United States, take note, most infections in 13- to 19-year-olds were in' females."

The risk of adverse outcomes related to antiretroviral prescriptions during pregnancy is low. Antiretrovirals were first given to pregnant women in the late 1980s, so the first children from these pregnancies are now 12-13 years old. "Few complications have been reported."