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, 76 cases of pediatric HIV infection have been diagnosed to date, 56 (74%) of whom are still assumed to be alive. Fifty-five (72%) of the 75 cases resulted from perinatal exposure, 9% were associated with hemophilia or other coagulation disorder, 5% associated with blood transfusion, and 13% were undetermined.
One of the 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% (1).
Preventive antiretroviral treatment can reduce this percentage to 1–2% (2). 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% between 1995 and 1999 (3).
For 15 years the number of births to HIV-infected women in Minnesota increased steadily from 14 in 1996 to 71 in 2009. In 2013, there were 62 births to HIV+ women. The rate of transmission has decreased from 15% between 1994 and 1996 to 0.5% in the past three years, with no HIV+ births to HIV+ mothers in Minnesota in 2013.
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.
(1) Conner EM, Sperling RS, Gelber R. et al. Reduction of Maternal-Infant Transmission of Human Immunodeficiency Virus Type 1 with Zidovudine Treatment. New England Journal of Medicine, 331(28): 1173-80, 1994.
(2) Cooper ER, Charurat M, Mofenson L, et al. Combination antiretroviral strategies for the treatment of pregnant HIV-1 infected women and prevention of perinatal HIV-1 transmission. Journal of Acquired Immune Deficiency Syndrome, 29:484-94, 2002.
(3) Bulterys M, Nolan ML, Jamieson DJ, Dominguez K, Fowler MG. Advances in the prevention of mother-to-child HIV-1 transmission: current issues, future challenges. AIDScience, 2(4):1-18, 2002.