Vicki B. Peters

Trends in Perinatal HIV Prevention in New York City, 1994–2003

OBJECTIVES We examined trends in perinatal HIV prevention interventions in New York City implemented during 1994 to 2003 to ascertain the success of the interventions in reducing perinatal transmission. METHODS We used data obtained from infant records at 22 hospitals. We used multiple logistic regression to analyze factors associated with prenatal care and perinatal HIV transmission. RESULTS We analyzed data for 4729 perinatally HIV-exposed singleton births. Of mothers with prenatal care data, 92% had prenatal care. The overall proportion who received prenatal care and were diagnosed with HIV before delivery was 86% in 1994 to 1996 and 90% in 1997 to 2003. Use of prenatal antiretrovirals among mothers who received prenatal care was 63% in 1994 to 1996 and 82% in 1997 to 2003. From 1994 to 2003, cesarean births among the entire sample increased from 15% to 55%. During 1997 to 2003, the perinatal HIV transmission rate among the entire sample was 7%; 45% of mothers of infected infants had missed opportunities for perinatal HIV prevention. During 1997 to 2003, maternal illicit drug use was significantly associated with lack of prenatal care. Lack of prenatal, intrapartum, and neonatal antiretrovirals; maternal illicit drug use; and low birthweight were significantly associated with perinatal HIV transmission. CONCLUSIONS Interventions for perinatal HIV prevention can successfully decrease HIV transmission rates. Ongoing perinatal HIV surveillance allows for monitoring the implementation of guidelines to prevent mother-to-child transmission of HIV and determining factors that may contribute to perinatal HIV transmission.

Hospitalization trends among children and youths with perinatal human immunodeficiency virus infection, 1990-2002.

Background: Major improvements in disease progression among HIV-infected children have followed the adoption of combination antiretroviral therapy. Methods: We examined trends in hospitalization rates between 1990–2002 among 3927 children/youths with perinatal HIV infection, ranging in age from newborn to 21 years. We used Poisson regression to test for trends in hospitalization rates by age and year; binomial regression to test for trends in intensive care unit (ICU) admissions and hospitalization at least once and more than once, by age and year; and multivariate logistic regression to examine factors associated with hospitalization, ICU admission, and hospitalization longer than 10 days. Results: Statistically significant downward trends in hospitalization rates and multiple hospitalizations were observed in all age groups from 1990–2002. The proportion of HIV-infected children/youths who were hospitalized at least once declined from 30.4% in 1990 to 12.9% in 2002, with a steady decline occurring after 1996, when the U.S. Public Health Service issued guidelines recommending triple-drug antiretroviral therapy (triple therapy) for HIV-infected children. ICU admissions declined significantly in all age groups except among children younger than 2 years. Logistic regression results indicated that black and Hispanic children/youths were significantly more likely to be hospitalized than white children/youths and that children/youths receiving triple therapy were significantly more likely to be hospitalized than therapy-naive children; the latter association was not observed among children monitored from 1997–2002. Conclusions: Substantial reductions in rates of hospitalization, multiple hospitalizations, and ICU admission have occurred among HIV-infected children/youths from 1990–2002, particularly after 1996, with increased use of triple therapy.

CORRELATION OF IMMUNE RESPONSES WITH HIV PLASMA VIREMIA. |[dagger]| 1074

We sought to correlate immunologic and clinical parameters with HIV-1 RNA plasma levels in a group of 14 HIV-infected children [mean CD4 count 617 cells/mm3 (range 10-2880). Plasma viremia was measured by RT-PCR assay(Roche Amplicor Kit). We analyzed T-cell responses to mitogens (PHA, Con-A, PWM) and antigens (tetanus, candida), T-suppressor cell activity, and humoral responses to H. influenzae, hepatitis B, tetanus, diphtheria vaccines. We compared characteristics according to viral load: low 100,000 copies/ml. Table

Cutaneous Herpes Simplex Virus Infection in a Child With Acquired Immunodeficiency Syndrome

Infections with herpes simplex virus (HSV) are common in children with human immunodeficiency virus (HIV) infection and can be severe and atypical.1 Herein, we report a case of a progressive wound of the hand associated with HSV type 1 in a child with the acquired immunodeficiency syndrome (AIDS).