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Perinatal Antiretroviral Exposure and Prevented Mother-to-child HIV Infections in the Era of Antiretroviral Prophylaxis in the United States, 19942010

Little, Kristen M. PhD, MPH; Taylor, Allan W. MD, MPH; Borkowf, Craig B. PhD; Mendoza, Maria C.B. PhD; Lampe, Margaret A. RN, MPH; Weidle, Paul J. PharmD, MPH; Nesheim, Steven R. MD

Pediatric Infectious Disease Journal: January 2017 - Volume 36 - Issue 1 - p 66–71
doi: 10.1097/INF.0000000000001355
HIV Reports

Objectives: Using published, nationally-representative estimates, we calculated the total number of perinatally HIV-exposed and HIV-infected infants born during 1978–2010, the number of perinatal HIV cases prevented by interventions designed for the prevention of mother-to-child transmission (PMTCT), and the number of infants exposed to antiretroviral (ARV) drugs during the prenatal and intrapartum periods.

Design: We calculated the number of infants exposed to ARV drugs since 1994, and the number of cases of mother-to-child HIV transmission prevented from 1994 to 2010 using published data. We generated confidence limits for our estimates by performing a simulation study.

Methods: Data were obtained from published, nationally-representative estimates from the Centers for Disease Control and Prevention. Model parameters included the annual numbers of HIV-infected pregnant women, the annual numbers of perinatally infected infants, the annual proportions of infants exposed to ARV drugs during the prenatal and intrapartum period and the estimated MTCT rate in the absence of preventive interventions. For the simulation study, model parameters were assigned distributions and we performed 1,000,000 repetitions.

Results: Between 1978 and 2010, an estimated 186,157 [95% confidence interval (CI): 185,312–187,003] HIV-exposed infants and approximately 21,003 (95% CI: 20,179–21,288) HIV-infected infants were born in the United States. Between 1994 and 2010, an estimated 124,342 (95% CI: 123,651–125,034) HIV-exposed infants were born in the US, and approximately 6083 (95% CI: 5931–6236) infants were perinatally infected with HIV. During this same period, about 100,207 (95% CI: 99,374–101,028) infants were prenatally exposed to ARV drugs. As a result of PMTCT interventions, an estimated 21,956 (95% CI: 20,191–23,759) MTCT HIV cases have been prevented in the United States since 1994.

Conclusion: Although continued vigilance is needed to eliminate mother-to-child HIV transmission, PMTCT interventions have prevented nearly 22,000 cases of perinatal HIV transmission in the United States since 1994.

From the *Centers for Disease Control and Prevention (CDC), Washington, DC; National Center for Viral Hepatitis, HIV/AIDS, Sexually-Transmitted Disease and Tuberculosis Prevention (NCHHSTP), Division of HIV/AIDS Prevention (DHAP), Epidemiology Branch, Atlanta, GA; and CDC, NCHHSTP, DHAP, Quantitative Sciences and Data Management Branch, Atlanta, GA.

Accepted for publication May 4, 2016.

K.M.L. performed the literature review, created tables and wrote the manuscript. A.W.T. assisted with the study design and manuscript writing and editing. C.B.B. performed the principal statistical analysis, wrote the methods section and assisted with table and figure preparation. M.C.B.M. assisted with the statistical analysis, methods writing and manuscript review. M.A.L. assisted with study design and manuscript preparation and editing. P.J.W. participated in the study design and analysis, and assisted in manuscript preparation and editing. S.R.N. was primarily responsible for study design, assisted with manuscript preparation and coordinated manuscript editing.

The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the U.S. Centers for Disease Control and Prevention.

The authors have no conflicts of interest or funding to disclose.

Address for correspondence: Kristen M. Little, PhD, MPH, Centers for Disease Control and Prevention, Population Services International, 1120 19th Street NW, Suite 600, Washington, DC 20036. E-mail: klittle@psi.org.

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