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Perinatal HIV Case Series Reports for Births in 2005-2006. Presenter: Elvia Ledezma Texas Department of State Health Services. Overview of Infected Children, 2005-2006 . In Texas 558 HIV+ women delivered in 2005-2006 13 children are HIV+ 2005-5 infected 2006-8 infected
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Perinatal HIV Case Series Reports for Births in 2005-2006 Presenter: Elvia Ledezma Texas Department of State Health Services
Overview of Infected Children, 2005-2006 • In Texas 558 HIV+ women delivered in 2005-2006 • 13 children are HIV+ • 2005-5 infected • 2006-8 infected • 2.3% of all births for this period are infected
Infected children born to HIV positive women living outside of Houston
Case #1 Demographics • Age 37; Single; Black/ Non-Hispanic; 4 previous pregnancies HIV/STD History • No STDs; + HIV test 14 years prior; AIDS one month after HIV diagnosis • Mode of Exposure-IV Drug Use Pregnancy • Limited Prenatal Care (1 to 2 visits) • No ART (non-compliant prior to pregnancy) Labor and Delivery • Receipt of ART • Elective C-Section (Viral Load-933,000 copies/mL ) • Toxicology Screen Positive for Cocaine (mother and infant) Birth History • Receipt of ART • 35 weeks gestation and 2075 grams in weight • No Breastfeeding Noted and Unknown if received PCP prophylaxis
Case #2 Demographics • Age 19; Single; Black/ Non-Hispanic; 3 previous pregnancies HIV/STD History • No STDs; 1st + HIV test at delivery (EIA, WB); AIDS 7 months after delivery • Mode of Exposure- Heterosexual Contact Pregnancy • No Prenatal Care • No ART Labor and Delivery • No ART • C-section of Unk. Type • Toxicology Screen Positive for Cocaine (mother only) Birth History • Twins • Receipt of ART 4 days after delivery • 40 weeks gestation and 2329 grams in weight • Unknown if Breastfed or if received PCP prophylaxis
Case #3 Demographics • Age 34; Single; Hispanic; No previous pregnancies HIV/STD History • STDs present at delivery; + HIV test 9 years prior; AIDS diagnosis at delivery • Mode of Exposure- Heterosexual Contact Pregnancy • No prenatal care reported • No ART Labor and Delivery • Receipt of ART • Elective C-Section • Toxicology Screen Positive for Cocaine (mother ) Birth History • Receipt of ART • 39 weeks gestation and 3585 grams in weight • Unknown if Breastfed or if received PCP prophylaxis
Case #4 Demographics • Age 27; Single; Black/Non-Hispanic; No previous pregnancies HIV/STD History • STDs present at delivery; + HIV test 2 years prior • Mode of Exposure- Heterosexual Contact Pregnancy • No prenatal care reported • No ART • CD4 Count (156) and Viral Load (1800 copies/ml) Labor and Delivery • Receipt of ART • Elective C-Section • Negative Toxicology Screen Birth History • Receipt of ART • 35 weeks gestation and 2315 grams in weight • No breastfeeding and unknown if received PCP prophylaxis
Case #5 Demographics • Age 28; Single; White/Non-Hispanic; 1 previous pregnancy HIV/STD History • No STDs; -HIV antibody test 6 months prior to deliv.; + HIV test 2 days after (PCR, EIA, WB) • Mode of Exposure- Not specified Pregnancy • Prenatal began in 2nd Trimester (10 visits) • No ART Labor and Delivery • No ART • Vaginal Delivery • Indication of drug use but no toxicology screen done Birth History • Receipt of ART (2 days after birth) • 39 weeks gestation and 3190 grams in weight • No breastfeeding and unknown if received PCP prophylaxis
Case #6 Demographics • Age 30; Married; Black/Non-Hispanic; 3 previous births HIV/STD History • No STDs; + HIV 2 months prior to delivery • Mode of Exposure- Not specified Pregnancy • Prenatal began in 3rd Trimester (1 visit) • No ART Labor and Delivery • Vaginal Delivery prior to arrival at the hospital • No ART • Positive Toxicology Screen (mother and child) • Viral Load (34,500 copies/ml)-after delivery Birth History • Receipt of ART • 40 weeks gestation and 2627 grams in weight • No breastfeeding and unknown if received PCP prophylaxis
Case #7 Demographics • Age 26; Single; Black/Non-Hispanic; Unknown pregnancy history HIV/STD History • No STDs; + HIV test 6 years prior; AIDS diagnosis during pregnancy • Mode of Exposure- Heterosexual Contact Pregnancy • Prenatal began in 2rd Trimester (3 visits) • Receipt of ART • CD4 (125) and Viral Load (49,800 copies/ml) Labor and Delivery • Vaginal Delivery • Receipt of ART • Positive Toxicology Screen (mother and child) Birth History • Receipt of ART • 35 weeks gestation and 2070 grams in weight • No breastfeeding and unknown if received PCP prophylaxis
Case #8 Demographics • Age 36; Single; White/Hispanic; 1 previous birth HIV/STD History • No STDs; + HIV test at delivery (EIA and WB) • Mode of Exposure- None specified Pregnancy • No prenatal care • No ART Labor and Delivery • Vaginal Delivery • No ART • No indication of substance use and no toxicology screen • Viral Load (750,000 copies/ml) Birth History • Receipt of ART • 38 weeks gestation and 3096 grams in weight • No breastfeeding and unknown if received PCP prophylaxis
Two Cases with Unknown Mode of Exposure • Due to limited information on the mother the children's mode of exposure is classified as “Pediatric Other/Undetermined” • Unknown locations of birth (Potential births outside of the U.S.) • Mothers are of Hispanic decent • Both children were adopted and are living in Texas
Demographics of HIV+ Women Delivering an Infected Child, 2005-2006 • Age Range: 62.5% of women were 25 to 34 years of age • Marital Status: 87.5% were single • Race/Ethnicity: 62.5% Black; 25% Hispanic; 12.5% White • More than half had a previous pregnancy • Average of 2 pregnancies for these 5 women
HIV/STD History of Women Delivering an Infected Child, 2005-2006 • STD at Delivery • 25% record of an infection • Mode of Exposure • 25% IV • 50% Heterosexual Contact
HIV/STD History of Women Delivering an Infected Child, 2005-2006 • Timing of HIV Test • 50% prior to delivery (Avg-8 years prior to delivery) • 12.5% during pregnancy • 25% at delivery • 12.5% after delivery • AIDS Diagnosis • 25% diagnosed during pregnancy or at delivery • 25% diagnosed after delivery
Overview of Women Delivering an Infected Child, 2005-2006 • Only half of women received prenatal care • Limited prenatal care visits (Range 1-10) • 87.5% did not receive ART during pregnancy • Only 50% received ART during delivery
Overview of Women Delivering an Infected Child, 2005-2006 • 100% received ART neonatally • 25% of children unknown if breastfed • 62.5% had a positive toxicology screen
Conclusion • EPSTexas Perinatal StatsCase Reports • Missed opportunity challenges • Lack of prenatal care • Lack of ART during pregnancy • Timing of HIV test results • Assure medical information is available • Prevention recommendations
Contact Information • Elvia Ledezma, MPH Epidemiologist Texas Department of State Health Services (512)-533-2045 elvia.ledezma@dshs.state.tx.us