Changing Epidemiology of Perinatal HIV-1 Infection in the United States

Abstract

After completing this article, readers should be able to: 1. Describe the prevalence of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) among all women in the United States and among those who are pregnant. 2. Describe the changing epidemiology of perinatal HIV infection. 3. List the barriers to prevention of perinatal HIV infection. The human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) pandemic has had a formidable impact on maternal and child health and survival, with global public health consequences. The Joint United Nations Program on HIV/AIDS estimated that there are more than 15 million women and 1.1 million children living with HIV/AIDS worldwide.1 Since the initial reports of AIDS cases among children in 1982 in the United States,2,3 HIV-1 infection has become one of the leading causes of morbidity and mortality among children worldwide.1,4 In the United States, HIV/AIDS was ranked as the seventh leading cause of childhood mortality among children 1 to 4 years of age in 1996.5 Perinatal transmission accounts for more than 90% of all pediatric AIDS cases and almost all new HIV-1 infections in children.6 In the United States and other developed countries, enormous progress has been made in preventing perinatal HIV-1 transmission, especially in the past 7 years. In 1994, the Pediatric AIDS Clinical Trials Group Protocol 076 (PACTG 076) report on the use of zidovudine (ZDV) in pregnant women who had HIV-1 infection and their infants revolutionized the prevention of perinatal HIV-1 transmission.7 The rate of perinatal transmission of HIV-1 was reduced significantly by an extended regimen of ZDV given during pregnancy, labor, and to the neonate.7 In 1995, the United States Public Health Service (USPHS) issued guidelines recommending universal counseling and testing for pregnant women and the use of ZDV to reduce perinatal transmission.8 …