Epidemiological Profile of HIV/AIDS in Minnesota
Infants and Children: HIV/AIDS Prevalence among Pediatrics
Pediatric Cases of HIV/AIDS
Pediatric cases are defined in accordance with the CDC criteria as those cases of HIV or AIDS who were less than 13 years of age at the time of test or diagnosis. In Minnesota, 75 cases of pediatric HIV infection have been diagnosed to date, 56 (75%) of whom are still assumed to be alive. Fifty-five (73%) of the 75 cases resulted from perinatal exposure, 9 percent were associated with hemophilia or other coagulation disorder, 5 percent associated with blood transfusion, and 12 percent were undetermined.
One of the few success stories in the history of HIV infection is the use of medication to successfully reduce perinatal transmission of the virus. Without treatment, the risk of HIV transmission from a pregnant woman to her child before or during birth is approximately 25 percent (Conner et al., 1994). Preventive antiretroviral treatment can reduce this percentage to 1–2 percent (Cooper et al., 2002). If breastfeeding is avoided, nearly all children born to HIV-infected mothers can be spared infection.
The U.S. Public Health Service released guidelines in 1994 for the use of zidovudine to prevent perinatal transmission of HIV and in 1995 recommended universal counseling and voluntary HIV testing for pregnant women. With the widespread adoption of these guidelines, perinatal HIV transmission in the United States decreased by 81 percent between 1995 and 1999 (Bulterys et al., 2002).
For 15 years the number of births to HIV-infected women increased steadily from 14 in 1996 to 71 in 2009. In 2012, there were 60 births to HIV+ women. The rate of transmission has decreased from 15 percent between 1994 and 1996 to 1.7 percent in the past three years, with one HIV+ birth to HIV+ mother in Minnesota in 2012. While there is no difference in the number of pregnancies, the difference in the rate of transmission has decreased nine-fold, from 18 percent in 1990–1995 to 2 percent in 1996–2012.
Reporting of births to HIV positive women is known to be incomplete. As a result of a project conducted in 2001, MDH has both implemented an active component for perinatal surveillance in collaboration with pediatric HIV clinicians in the Twin Cities to increase reporting of births to HIV-infected mothers, and in 2005 changed reporting rules to explicitly state that a pregnancy in an HIV-positive woman is a reportable condition. In addition, surveillance staff matches surveillance records with vital statistics records on a yearly basis to identify births to HIV positive women. Despite these efforts, reporting of pregnancy among women living with HIV/AIDS continues to be incomplete.