Ongoing Maternal-Child Transmission of HIV in an Urban Area, 2003-2012.

BACKGROUND AND OBJECTIVE Mother-to-child transmission of HIV can be prevented by prenatal and peripartum interventions. We sought to determine the prevalence of vertical HIV transmission in an urban cohort of HIV-exposed infants and describe cases of vertical HIV infection presenting during and after the neonatal period. METHODS This retrospective cohort study included HIV-exposed infants born between July 1, 2003, and June 30, 2012, who received care at an urban referral site. RESULTS There were 516 infants with HIV exposure known by the time of delivery; 9 of these infants (1.7%; 95% confidence interval: 0.8%-3.3%) were HIV infected. The HIV infection rate was 0.7% for those receiving prenatal antiretroviral (ARV) therapy and 9.3% for those receiving only intrapartum and/or postnatal ARV therapy. Among those diagnosed with HIV at delivery, 46% received no prenatal care. CONCLUSIONS Our data suggest that strategies to eliminate infant HIV infections ought to include ensuring better access to prenatal care, HIV testing, and ARV therapy initiation during pregnancy.