Use of interventions for reducing mother-to-child transmission of HIV in Australia.
OBJECTIVE
To describe the extent and outcome of use of interventions for reducing the risk of HIV transmission from mother to child in Australia.


METHODS
National surveillance for perinatal exposure to HIV.


METHODS
Notified cases of HIV infection in women in Australia and their perinatally exposed children, 1982-1999.


METHODS
Trends over time in use of interventions (antiretroviral therapy in pregnancy, elective caesarean delivery and avoidance of breastfeeding) and perinatally acquired HIV infection.


RESULTS
By 31 March 2000, 204 children were reported as having been born in 1982-1999 to 162 women whose HIV infection had been diagnosed by 31 December 1999. The child's HIV infection status was established for 182 (89.2%); the mother's HIV infection was diagnosed antenatally in 91 of these cases (50%). Among women diagnosed antenatally, use of elective caesarean delivery and antiretroviral therapy in pregnancy increased significantly, from 3% and 14% by women whose children were born in 1982-1993, to 21% (P=0.01) and 88% (P<0.001), respectively, by women whose children were born in 1994-1999. Most women (95%) diagnosed antenatally avoided breastfeeding their children. The percentage of infected children born to women diagnosed antenatally declined from 26% among children born in 1982-1993 to 19% among those born in 1994-1999. The percentage of infected children was significantly lower among those whose mothers used antiretroviral therapy in pregnancy (11% versus 36%; P=0.03).


CONCLUSIONS
Antiretroviral use in pregnancy, elective caesarean delivery and avoidance of breastfeeding have been effective interventions for reducing the risk of mother-to-child HIV transmission in Australia. While the rate of perinatal HIV transmission has declined, it remains high in comparison with rates reported from other industrialised countries.
McDonald
A M
AM
National Centre in HIV Epidemiology and Clinical Research, Sydney, NSW. amcdonald@nchecr.unsw.edu.au
Li
Y
Y
Cruickshank
M A
MA
Elliott
E J
EJ
Kaldor
J M
JM
Ziegler
J B
JB
D000163:Acquired Immunodeficiency Syndrome / Q000517:prevention & control* / Q000635:transmission*; D000998:Antiviral Agents / Q000627:therapeutic use*; D001315:Australia; D001942:Breast Feeding / Q000009:adverse effects; D002585:Cesarean Section; D003625:Data Collection; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D011159:Population Surveillance; D011247:Pregnancy; D012307:Risk Factors
D000998:Antiviral Agents