Prevention of Perinatal HIV Transmission in an Area of High HIV Prevalence in the United States.

Objective To evaluate the uptake of perinatal HIV preventive interventions by risk of perinatal HIV transmission in mother-infant pairs in a high HIV prevalence area in the United States (US). Study design This was a retrospective cohort study of mother-infant pairs with perinatal HIV exposure during 2013-2017 managed at a subspecialty pediatric HIV program in Washington, DC. We collected demographics, maternal HIV history, delivery mode, maternal and infant antiretroviral drug (ARV) use, and infant’s HIV test results. We compared the uptake of recommended preventive interventions in low-risk (mothers on ARVs with viral suppression) and high-risk (mothers without ARVs or viral suppression) mother-infant pairs using Pearson Chi-square, Fisher exact, Wilcoxon rank sum tests, and logistic regression. Results We analyzed 551 HIV-exposed infants and 542 mothers living with HIV. The majority of mothers received ARVs (95.5%), had HIV RNA ≤1,000 copies/mL before delivery (81.9%), and received intrapartum zidovudine (65.5%). The majority of all HIV-exposed infants was low-risk (82.6%) and received postpartum ARVs (98.9%). Among low-risk infants, 53.2% were delivered via cesarean delivery, and 62.9% and 96.5% were administered intrapartum and postpartum zidovudine, respectively. Among high-risk infants, 84.4% were delivered via cesarean delivery, 78.1% received intrapartum zidovudine, and 62.5% received combination ARVs. Nine high-risk infants acquired HIV perinatally. Conclusion In an area of high HIV prevalence in the US, a large proportion of low-risk HIV-exposed infants received intrapartum zidovudine and was delivered via cesarean delivery. We also observed missed opportunities for the prevention of perinatal HIV transmission.