Cases of Perinatal HIV Transmission Down 10-Fold Since 1994.

CHICAGO -- Perinatal HIV transmission has decreased 10-fold in the United States since 1994, Dr. Lynne M. Mofenson reported at the annual meeting of the American Academy of Pediatrics.

The number of HIV-infected infants has dropped from about 2,000 per year prior to the adoption of routine testing and prophylaxis of infected mothers in 1994 to only about 200 annually today. "Eradication of perinatal HIV infection is within our reach, but there is still a way to go before it's a reality," said Dr. Mofenson of the pediatric adolescent and maternal AIDS branch at the National Institute of Child Health and Human Development in Bethesda, Md.

The landmark 1994 study known as ACTG 076 showed that a three-part regimen of zidovudine given to a patient during pregnancy and labor and to the infant for the first 6 weeks of life decreased the HIV transmission rate by 68%. In 1996, the use of more complex prophylactic regimens with and without protease inhibitors was introduced, and these regimens are now the standard of care.

Prior to 1994, when HIV-infected women were given only prenatal zidovudine or nothing, the perinatal HIV transmission rate was 20%-25%. By 1999, the rate had dropped to 3%. "It's now a preventable disease," said Dr. Mofenson, who chaired the public health task force that developed the national recommendations for the use of antiretroviral drugs in HIV-positive pregnant women.

But infected babies continue to be born despite the success of prophylaxis. A major problem is that the demographic group most likely to become HIV infected today is the same group most likely to get pregnant and not receive prenatal care.

In a 1999 study of states with HIV reporting, 64% of 13- to 19-year-olds who were HIV infected were female, compared with 44% of the 20- to 24-year-olds and only 29% of those older than 25. In the age 13-19 group, 52% with AIDS and 50% of the females with HIV were reported to have become infected through heterosexual contact. But further investigation showed that the true proportion was actually more than 90%, Dr. Mofenson commented.

Another study of a population aged 20 and younger (the Job Corps) revealed an overall HIV prevalence of 2.8/1,000 females, compared with 2/1,000 males. African American females had the highest rate: 4.9/1,000.