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Singh S, Lampe M, Surendera Babu A, Rao S, Borkowf CB, Nesheim SR

HIV Seroconversion During Pregnancy and Mother-to-Child HIV Transmission: Data from Enhanced Perinatal Surveillance, United States, 2005-2010. Singh S, Lampe M, Surendera Babu A, Rao S, Borkowf CB, Nesheim SR. XIX International AIDS Conference Washington, DC July 26, 2012

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Singh S, Lampe M, Surendera Babu A, Rao S, Borkowf CB, Nesheim SR

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  1. HIV Seroconversion During Pregnancy and Mother-to-Child HIV Transmission:Data from Enhanced Perinatal Surveillance, United States, 2005-2010 Singh S, Lampe M, Surendera Babu A, Rao S, Borkowf CB, Nesheim SR XIX International AIDS Conference Washington, DC July 26, 2012 No financial relationships to disclose National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of HIV/AIDS Prevention

  2. Background • In the US, the Centers for Disease Control and Prevention (CDC) recommends that opt-out HIV screening be included in the routine panel of prenatal screening tests for all pregnant women • In addition, CDC recommends repeat third-trimester testing in areas with elevated HIV infection among pregnant women and women at high risk • Decline in mother-to-child transmission (MCT) in the US since the early 1990s CDC. Revised Recommendations for HIV Testing of Adults, Adults, Adolescents, and Pregnant Women in Health-Care Settings. MMWR, September 22, 2006, 55(RR14);1-17.

  3. Background • Acquisition and transmission of HIV by women is higher during pregnancy1 • Studies of acute infection during pregnancy in the US include: • Birkhead et al (2010)2 reported 13.8% (9/65) in New York City of perinatal infections occurred in maternal primary infection • Patterson et al (2007)3 reported 50% (3/6) in North Carolina of perinatal infections occurred in maternal primary infection • Acute infection during pregnancy can lead to higher MCT due to increased viral load during acute infection4 1Mugo NR et al. AIDS 2011;25:1887-1895. 2Birkhead GS et al. ObstetGynecol 2010;115:1247-55. 3Patterson KB et al. AIDS 2007;21:2303-2308. 4Marinda ET et al. IntJ Epid 2011;40:945-954.

  4. Objectives • To estimate the numbers of seroconversions during pregnancy (DP) and prior-to-pregnancy (PTP) • To examine the maternal and infant characteristics and uptake of interventions between DP and PTP seroconverters • To determine the proportion of perinatal infection which occur in the context of maternal primary infections • To compare the MCT between DP and PTP seroconverters

  5. Enhanced Perinatal Surveillance • EPS is a population‑ or facility-based surveillance system for HIV‑infected mothers and their perinatally-exposed children • EPS includes • Case ascertainment • Linking of mother‑infant pairs • Review of medical records for HIV testing history, prenatal care and treatment, follow‑up to assess infection status of infants and initiation of HIV‑related care • Data sources • Prenatal care records • Labor and delivery charts • Pediatric HIV medical records • Birth and death certificates • Mother’s HIV medical records for care • Health department record

  6. CT NJ NY DE MD SC GA LA TX PR

  7. Methods • HIV-infected women who delivered live infants 2005-2010 • EPS data linked with National HIV Surveillance System data through June 2011 • Determined number of DP and PTP seroconverters • DP seroconvertershad negative HIV test during pregnancy and positive HIV test during pregnancy, labor/delivery or 90 days after infant date of birth • PTP seroconvertersdiagnosed prior to pregnancy

  8. Methods • Comparisons were limited to DP and PTP seroconverters • Differences in characteristics and intervention uptake between DP and PTP seroconverters assessed by the chi-squared test • Determined proportion of perinatal infection which occur in the context of maternal primary infections • Calculated MCT among DP and PTP seroconverters • Estimated annual percent change used to examine trends in percentages of DP and PTP seroconverters and MCT in seroconverter groups

  9. Assumptions for Handling Missing Data • Conditions • Used infant date of birth to replace missing HIV positive test date • If HIV positive or negative tests missing, used additional information from EPS questionnaire • Initiation of ART • Variable on mother’s HIV status • HIV-positive before this pregnancy • HIV-positive at the time of delivery

  10. Results

  11. HIV Seroconversions During Pregnancy and Prior-to-Pregnancy, EPS, 2005-2010 *Estimated Annual Percent Change p<0.0001)

  12. Maternal Characteristics Among DP and PTP Seroconverters, EPS, 2005-2010*

  13. Maternal Characteristics Among DP and PTP Seroconverters, EPS, 2005-2010*

  14. Infant Characteristics by Maternal Time of Seroconversion, EPS, 2005-2010*

  15. Maternal and Infant Interventions Among DP and PTP Seroconverters, EPS, 2005-2010*

  16. Maternal and Infant Interventions Among DP and PTP Seroconverters, EPS, 2005-2010*

  17. 36+ Weeks 28-36 Weeks

  18. Perinatal HIV Transmission Among DP and PTP Seroconverting Women, EPS, 2005-2010

  19. Limitations • EPS is a population-based and facility-based surveillance system and cannot be generalized to determine national estimates • Surveillance areas use specific methods based on HIV-reporting laws or Institutional Review Board assurance which may result in variation in data collection methods • Completeness of data including negative test date

  20. Discussion • From 2005 to 2010 there was a 25% estimated annual increase in the percent of DP seroconverters • Unadjusted differences observed between PTP and DP seroconverters include mode of delivery, breastfeeding, HIV infection status of infant and ARVs • MCT occurred among 2.0% of all deliveries and MCT among DP seroconverters was 12.9% and PTP seroconverters was 1.6% • The proportion of perinatal infection which occur in the context of maternal primary infections was 7.6% • Only 23.4% of DP seroconverters were tested during the CDC-recommended third trimester period

  21. Conclusion Mother-to-child transmission could be further reduced by greater adherence to CDC (2006) recommendations in the Revised Recommendations for HIV Testing of Adults, Adults, Adolescents, and Pregnant Women in Health-Care Settings CDC’s HIV Testing Recommendations:  http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm/

  22. Acknowledgements CoauthorsEPS Program Margaret Lampe Suzanne Whitmore Aruna Surendera Babu Gary Weeks ShubhaRaoVeenaMinasandram Craig BorkowfSabithaDasari Steve Nesheim Renee Freeman Grantee staff Previous WorkEPS Participants Stephanie Sansom Nan Ruffo

  23. Sonia Singh, PhD MHSEpidemiologistHIV Incidence and Cases Surveillance BranchDivision of HIV/AIDS PreventionNational Center for HIV/AIDS, Viral Hepatitis, STD and TB PreventionCenters for Disease Control and Prevention1600 Clifton Road NE, MS E-47Atlanta, GA 30333Phone:  (404) 639-6337E-mail:  ssingh3@cdc.gov For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA 30333 Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: cdcinfo@cdc.gov Web: http://www.cdc.gov The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of HIV/AIDS Prevention

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