Search

Objective: The primary aim of this serial cross‐sectional analysis is to estimate the total number of prevented perinatal HIV transmissions from the time of the initial recommendation for perinatal zidovudine (ZDV) prophylaxis in 1994 through 2020 in the US. Methods: The estimated number of prevented transmissions was calculated as annual differences between expected and observed numbers of perinatal HIV transmissions. Annual expected number of transmissions was estimated by multiplying the annual number of births to women with HIV by 0.2255 (22.55%), i.e., the transmission rate of the control group in the ACTG Protocol 076 trial. We used published point estimates or, if only ranges were given, the midpoints of those ranges as the best estimates of the annual numbers of births to women with HIV and infants with perinatal HIV. When data were not available, we linearly interpolated or extrapolated the available data to obtain estimated numbers for each year. Results: Between 1978 and 2020, the approximate number of live births to women with HIV was 191 267 (95% confidence interval [CI] 190 392–192 110) and for infants with diagnosed perinatal HIV, it was 21 379 (95% CI 21 088–21 695). Since 1994, the annual number of infants born with HIV decreased from 1263 (95% CI 1194–1333) to 33 in 2019 (95% CI 22–45) and 36 in 2020 (95% CI 25–48), corresponding to a 97% reduction. Cumulatively, an estimated total of 22 732 (95% CI 21 340–24 462) perinatal HIV infections were prevented from 1994 through to 2020. Conclusion: The elimination of perinatal HIV transmission—accompanied by the cumulative number of prevented cases exceeding that of perinatal HIV infections—is a major public health achievement in the US. Synopsis: Annual numbers of perinatal HIV infections have decreased by 97% since 1994, and 22 732 perinatal HIV infections have been prevented in the US from 1994 through to 2020. [ABSTRACT FROM AUTHOR]

The HIV/AIDS epidemic has been one of the greatest challenges in global health, significantly affecting women of reproductive potential. Considerable advances in antiretroviral therapy for women living with HIV have contributed to improvements in quality of life, better reproductive and birth outcomes, and a reduced risk of perinatal transmission. Despite the progress made, persistent challenges in access and adherence to antiretroviral drugs may limit their benefits for some women. More pharmacokinetic and safety studies in pregnant and lactating women are urgently needed, as are prospective surveillance systems to evaluate associations between fetal and infant antiretroviral exposures, drug–drug interactions, and pregnancy outcomes. Multipurpose technologies, such as combined HIV and other STI or unintended pregnancy prevention, and innovative delivery methods, such as the development of long-acting antiretrovirals, have the potential to reduce adherence challenges and enhance quality of life for women with HIV. Parallel advances in drug safety testing and surveillance are needed to ensure the health and safety of women with or at risk for HIV and children at risk for perinatal transmission. [ABSTRACT FROM AUTHOR]

Pregnant persons with chronic health conditions often require pharmacotherapy to remain healthy. The Antiretroviral Pregnancy Registry is a prospective, international, voluntary, and exposure registry that collects information on antiretroviral (ARV) exposure; however, a minority of providers use the registry, leaving critical gaps to guide prescribing in this population. The Task Force for the Elimination of Perinatal HIV Transmission in the United States, funded by the Centers for Disease Control and Prevention, has identified the monitoring of ARV safety as a paramount concern in the ongoing mission to eliminate perinatal human immunodeficiency virus (HIV) transmission. As active members of this task force, we urge all healthcare providers who care for pregnant individuals to prioritize reporting all ARV exposures to the registry. [ABSTRACT FROM AUTHOR]

Routine voluntary HIV testing with the right to decline (the 'opt-out' approach) is recommended for all pregnant women in the United States but not all are tested. We examined data from surveys of prenatal care providers to identify factors associated with universal testing among patients. Data are from a probability survey conducted in 1999 with prenatal care providers in four separate areas. Survey participants completed a self-administered questionnaire. We computed the percentage of providers reporting universal testing by characteristics of the provider's practice, medical specialty, how strongly they encouraged testing, perceptions of patients' risk, and whether they saw patients in public clinics. In the four locations (Brooklyn, New York; North Carolina; Connecticut; and Dade County, Florida) 95%-99% of providers reported that they routinely offered HIV testing to all pregnant women; the average percentage tested was 64%-89%. The percentage reporting that all of their patients were tested ranged from 12%-62%. The percent of providers reporting universal testing was positively associated with the degree to which testing was encouraged, particularly encouragement to women perceived to be low risk. In some areas, universal testing varied by medical profession, with obstetric physicians and residents, and nurse-midwives reporting a lower percentage of universal testing than family practice physicians and residents. To achieve the goal of routine HIV testing of all pregnant women, education and training must be delivered to all prenatal care providers. This training should emphasize the importance of routine testing. Even with the opt-out approach, many women may decline testing if their doctor does not recommend and encourage HIV testing.