In this podcast, CDC’s Dr. Steve Nesheim discusses perinatal HIV transmission, including the importance of preventing HIV among women, preconception care, and timely HIV testing of the mother. Dr. Nesheim also introduces the revised curriculum Eliminating Perinatal HIV Transmission intended for faculty of OB/GYN and pediatric residents and nurse midwifery students. Created: 11/26/2012 by Division of HIV/AIDS Prevention.
Date Released: 11/26/2012. Series Name: CDC Audio Rounds.
This program is presented by the Centers for Disease Control and Prevention.
Perinatal HIV transmission is the most common cause of HIV infection in children, accounting for 91percent of all AIDS cases among children in the United States.
Welcome to CDC Audio Rounds. I’m Dr. Steve Nesheim from the Division of HIV/AIDS Prevention at the Centers for Disease Control and Prevention.
The rate of mother-to-child transmission, or MCT, has decreased dramatically since the mid-1990s. This decrease is due in large part to increased HIV testing and the use of antiretroviral therapy, or ART, during pregnancy. The use of ART during pregnancy can reduce the perinatal HIV transmission rate to less than two percent. Without treatment, the transmission rate is estimated at 18 to 32 percent.
There are some key points in the ongoing battle to eliminate perinatal HIV transmission. Most new infections are attributable to a failure to perform well-established interventions, including the prevention of HIV among women, preconception care, and timely HIV testing of the mother.
For women known to be HIV-infected, health care providers need to inquire about pregnancy intentions and work closely with patients who wish to conceive. To help prevent perinatal transmission, interventions include the use of ARTs, cesarean delivery for women with unsuppressed viral load, and avoidance of breast feeding. Recent data show that more than half of infant infections were attributable to missed opportunities to perform these well-established interventions.
The health inequities represented in the number of perinatal HIV infections are of significant concern. From 2004 to 2007, African American and Hispanic infants accounted for 85 percent of perinatal diagnoses, although only 15 percent of infants are African American and 22 percent are Hispanic.
The annual number of pregnancies among HIV-infected women seems to be increasing. From 2000 to 2006, the number of HIV-infected women in the US who delivered infants increased by 39 percent. Remember, if we reduce the number of missed opportunities, more of these babies will be born HIV-free.
Eliminating perinatal HIV transmission is now conceptually possible. In 2006, CDC issued revised recommendations for universal HIV screening early in pregnancy. CDC has also developed the One Test. Two Lives.TM campaign and curriculum. The curriculum is designed primarily for OB/GYN and midwifery faculty and teaching professionals in order to deliver the content to a new generation of providers. It’s accredited for medical education and nursing contact hours.