title: Decline in perinatal HIV transmission in New York State (1997-2000).
abstract: BACKGROUND
  Perinatal HIV transmission has declined significantly in New York State (NYS) since implementation of a 3-part regimen of zidovudine prophylaxis in the antenatal, intrapartum, and newborn periods. This study describes the factors associated with perinatal transmission in NYS from 1997 to 2000, the first 4 years of NYS's comprehensive program in which all HIV-exposed newborns were identified through universal HIV testing of newborns.
  
  
  METHODS
  This population-based observational study included all HIV-exposed newborns whose infection status was known and their mothers identified in NYS through the universal Newborn HIV Screening Program (NSP) from February 1997 to December 2000. Antepartum, intrapartum, newborn, and pediatric medical records of HIV-positive mothers/infants were reviewed for history of prenatal care, antiretroviral therapy (ART), and infant infection status. Risks associated with perinatal HIV transmission were examined.
  
  
  RESULTS
  Perinatal HIV transmission declined significantly from 11.0% in 1997 to 3.7% in 2000 (P < 0.05). Prenatal ART was associated with a decline in perinatal HIV transmission both for monotherapy (5.8%, relative risk [RR] = 0.3, 95% confidence interval: 0.2%-0.5%) and combination therapy [2.4%, RR = 0.1, 95% confidence interval: 0.1%-0.2%) compared with no prenatal antiretroviral prophylaxis (P < 0.05).
  
  
  CONCLUSIONS
  Public health policies to improve access to care for pregnant women and advances in clinical care, including receipt of appropriate preventive therapies, have contributed to declines in perinatal HIV transmission in NYS.
authors.affiliation: AIDS Institute, Albany, NY, USA. naw02@health.state.ny.us
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Wade
authors.forename: Mary A
authors.initials: MA
authors.lastname: Zielinski
authors.forename: Maia
authors.initials: M
authors.lastname: Butsashvili
authors.forename: Louise-Anne
authors.initials: LA
authors.lastname: McNutt
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Warren
authors.forename: Roberta
authors.initials: R
authors.lastname: Glaros
authors.forename: Babu
authors.initials: B
authors.lastname: Cheku
authors.forename: Wendy
authors.initials: W
authors.lastname: Pulver
authors.forename: Kenneth
authors.initials: K
authors.lastname: Pass
authors.forename: Kathleen
authors.initials: K
authors.lastname: Fox
authors.forename: Antonia C
authors.initials: AC
authors.lastname: Novello
authors.forename: Guthrie S
authors.initials: GS
authors.lastname: Birkhead
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage; D001724:Birth Weight; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology / Q000635:transmission*; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D008297:Male; D009518:New York / Q000453:epidemiology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000453:epidemiology; D011295:Prenatal Care; D012307:Risk Factors; D013997:Time Factors
chemical_list: D019380:Anti-HIV Agents