Perinatal HIV Nearly Eradicated in US

Amanda Schmidt

April 18, 2023

Rates of perinatal HIV have dropped so much that the disease is effectively eliminated in the United States, with less than 1 baby for every 100,000 live births having the virus, a new study released today by researchers at the Centers for Disease Control and Prevention finds.

The report marks significant progress on the US government's goal to eradicate perinatal HIV, an immune-weakening and potentially deadly virus that is passed from mother to baby during pregnancy. Just 32 children in the country were diagnosed in 2019, compared to twice as many in 2010, according to the CDC. 

Mothers who are HIV positive can prevent transmission of the infection by receiving antiretroviral therapy, according to Monica Gandhi, MD, MPH, a professor of medicine at University of California San Francisco's division of HIV, Infectious Disease and Global Medicine.  

Gandhi said she could recall only one case of perinatal HIV in the San Francisco area over the last decade. 

"This country has been really aggressive about counseling women who are pregnant and getting mothers in care," Gandhi said.

The treatment method was discovered more than 30 years ago. Prior to the therapy and ensuing awareness campaigns to prevent transmission, mothers with HIV would typically pass the virus to their child in utero, during delivery, or while breastfeeding.

"There should be zero children born with HIV, given that we've had these drugs for so long," Ghandi said. 

Disparities Persist

But challenges remain in some communities, where babies born to Black mothers are disproportionately affected by the disease, the new study found. 

"Racial and ethnic differences in perinatal HIV diagnoses persisted through the 10-year period," the report's authors concluded. "The highest rates of perinatal HIV diagnoses were seen among infants born to Black women." 

Although rates of perinatal HIV declined for babies born to Black mothers over the decade-long study, the diagnosis rate was above the goal of elimination at 3.1 for every 100,000 live births, according to the data. 

Meanwhile, transmission rates hovered around 1% to 2% for Latinx and Hispanic women and mothers who identified as "other races," including Native American.  

Despite the availability of medication, expectant mothers may face several hurdles to getting the daily treatment they need to prevent transmission to their fetus, according to Jennifer Jao, MD, MPH, a physician of infectious diseases at Lurie Children's Hospital of Chicago. 

They might have trouble securing health insurance, finding transportation to doctor's appointments, or face other problems like lacking secure housing or food — all factors that prevent them from prioritizing the care. 

"All of those things play into the mix," Jao said. "We see over and over again that closing the gap means you've got to reach the women who are pregnant and who don't have resources." 

Progress in "Danger" 

Experts said they're not sure what the impact of the COVID-19 pandemic, accompanied by a recent uptick in sexually transmitted diseases, will be on rates of perinatal HIV. Some women were unable to access prenatal health care during the pandemic because they couldn't access public transportation or childcare, the US Government Accountability Office said last year

Globally, a decline in rates of HIV and AIDS rates has slowed, prompting the World Health Organization to warn last year that progress on the disease is in danger. Researchers only included HIV rates in the United States through 2019, so the data are outdated, Gandhi noted. 

"All of this put together means we don't know where we are with perinatal transmission over the last 3 years," she said. 

In an accompanying editorial, co-authors Nahida Chakhtoura, MD, MsGH, and Bill Kapogiannis, MD, both with the National Institutes of Health, urge healthcare professionals to take an active role in eliminating these racial and ethnic disparities in an effort to — as the title of their editorial proclaims — achieve a "road to zero perinatal HIV transmission" in the United States.

"The more proactive we are in identifying and promptly addressing systematic deficiencies that exacerbate health inequities in cutting-edge research innovations and optimal clinical service provision," they write, "the less reactive we will need to be when new transmissible infections appear at our doorstep."

Pediatrics. Published online April 18, 2023. Abstract, Editorial

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