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BACKGROUND: Pennsylvania (PA) has required perinatal exposure to HIV reporting since October 2002. To increase completeness of reporting, we made concerted efforts to engage major birthing hospitals in Pennsylvania to report perinatal exposure to HIV cases. The objective of this project was to utilize the reported data for 2012 to create a comprehensive profile of mother/infant pairs exposed to HIV.
METHODS: Data were abstracted from both the PA National Electronic Disease Surveillance System (PA-NEDSS) and eHARS databases. HIV exposed infants born in 2012 in Pennsylvania, excluding Philadelphia County, were selected.
RESULTS: The total cohort was 76 mother-infant pairs reported by 29 different facilities. Infant gender was 57% male and 43% female. Mother’s race was 53% African-American, 29% White and 18% Hispanic. Mother’s risk was 50% heterosexual contact with a person with HIV, 14% were second generation cases (mother was a perinatal exposure), 11% injecting drug users (IDU), 17% undetermined risk, 5% had sex with an IDU and 3% had sex with a bisexual male. Twenty-one percent of the mothers were born outside of the United States. Average length of time the mother was infected with HIV prior to the birth of the child was 6.6 years. In three of the cases, the mother was diagnosed after the birth of the child. Forty-five percent of mothers were documented as receiving some prenatal care. Sixty-three percent of mothers received anti-retrovirals (ARVs) during their pregnancy. Fifty-four percent received ARVs during labor and delivery. More than half (53%) were vaginal and 39% were caesarean sections. Of the 76 pairs, 23 (30%) were seroreverters. Four were pediatric HIV cases and the remaining 50 have insufficient documentation for a final diagnosis. The second generation cases were younger, more likely to be associated with a risk of IDU or sex with an IDU and were clustered in the south central and southeastern areas of PA. While this group tended to be in HIV care, based on lab results, they were not all well controlled at time of the birth.
CONCLUSIONS: PA continues its efforts to improve completeness of perinatal exposure to HIV reporting. Better documentation of mother’s risk, prenatal care and final diagnosis are needed. Observation among second generation cases has significant public health implications with respect to treatment and prevention. Further investigation is needed to fully characterize this potentially increasing sub-cohort for prevention initiatives.