Perinatal exposure to HIV among children born in Australia, 1982-2006.
OBJECTIVE
To describe the pattern of perinatal HIV exposure and outcomes among children born in Australia, 1982-2006.


METHODS
National surveillance for perinatal HIV exposure.


METHODS
Women with HIV infection and their perinatally exposed children.


METHODS
Trends in the age-standardised rate of perinatal exposure, uptake of interventions by women with an antenatal HIV diagnosis, and rate of mother-to-child transmission.


RESULTS
Between 1982 and 2006, there were 354 reported cases of perinatal HIV exposure among children born in Australia. The age-standardised rate of perinatal exposure per 100,000 live births increased from 2.3 (1982-1986) to 5.1 (1991-1998), 9.9 (1999-2002) and 8.3 (2003-2006). Among children whose mother was diagnosed antenatally, the mother-to-child transmission rate declined significantly, from 25% (4/16; 95% CI, 7%-52%) in 1987-1990 to 5% (4/82; 95% CI, 1%-12%) in 2003-2006 (P < 0.001). The rate declined from 8% (4/51; 95% CI, 2%-19%) in 1987-1998 to 1% (2/151; 95% CI, 0.2%-5%) in 1999-2006 among children whose mother used at least two interventions. Mother-to-child transmission remained high among children born to women diagnosed postnatally (39/87, 45%; 95% CI, 34%-56%) and to women diagnosed antenatally who used no interventions (7/15, 47%; 95% CI, 21%-73%).


CONCLUSIONS
The increasing rate of perinatal exposure and the decreasing rate of mother-to-child transmission among children whose mothers' HIV infection was diagnosed antenatally were temporally associated with use of interventions for minimising mother-to-child transmission. Mother-to-child transmission remained high when the mother's HIV infection was not known during pregnancy.
National Centre in HIV Epidemiology and Clinical Research, Sydney, NSW. amcdonald@nchecr.unsw.edu.au
Ann M
AM
McDonald
Yvonne A
YA
Zurynski
Handan C
HC
Wand
Michelle L
ML
Giles
Elizabeth J
EJ
Elliott
John B
JB
Ziegler
John M
JM
Kaldor
D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D001315:Australia / Q000453:epidemiology; D001942:Breast Feeding; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000635:transmission*; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D012189:Retrospective Studies; D055815:Young Adult
D044966:Anti-Retroviral Agents