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Perinatal exposure to HIV among children born in Australia, 1982–2006

Med J Aust 2009; 190 (8): 416-420.

Summary

Objective: To describe the pattern of perinatal HIV exposure and outcomes among children born in Australia, 1982–2006.

Design and setting: National surveillance for perinatal HIV exposure.

Participants: Women with HIV infection and their perinatally exposed children.

Main outcome measures: 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%).

Conclusion: 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.

  • Ann M McDonald1
  • Yvonne A Zurynski2
  • Handan C Wand1
  • Michelle L Giles3,4
  • Elizabeth J Elliott2,5
  • John B Ziegler6,7
  • John M Kaldor1

  • 1 National Centre in HIV Epidemiology and Clinical Research, Sydney, NSW.
  • 2 Australian Paediatric Surveillance Unit, Children’s Hospital at Westmead, Sydney, NSW.
  • 3 Infectious Diseases Unit, Alfred Hospital, Melbourne, VIC.
  • 4 Department of Medicine, University of Melbourne, Melbourne, VIC.
  • 5 Children’s Hospital at Westmead Clinical School, University of Sydney, Sydney NSW.
  • 6 Sydney Children’s Hospital, Sydney, NSW.
  • 7 School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW.


Acknowledgements: 

The National Centre in HIV Epidemiology and Clinical Research (NCHECR) is funded by the Australian Government Department of Health and Ageing, and is affiliated with the Faculty of Medicine, University of NSW. Its work is overseen by the Ministerial Advisory Committee on AIDS, Sexual Health and Hepatitis. The NCHECR Surveillance Program is a collaborating unit of the Australian Institute of Health and Welfare. The APSU is supported by the Australian Government Department of Health and Ageing, the National Health and Medical Research Council (Enabling Grant No. 402784 and Practitioner Fellowship No. 457084: Elizabeth Elliott), Discipline of Paediatrics and Child Health and Faculty of Medicine at the University of Sydney, the Children’s Hospital at Westmead, and the Division of Paediatrics and Child Health, Royal Australasian College of Physicians. We thank all reporting clinicians who participate in monthly surveillance and reported cases to this study.

Competing interests:

None identified.

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