摘要：Objectives . We examined trends in perinatal HIV prevention interventions in New York City implemented during 1994 to 2003 to ascertain the success of the interventions in reducing perinatal transmission. Methods . We used data obtained from infant records at 22 hospitals. We used multiple logistic regression to analyze factors associated with prenatal care and perinatal HIV transmission. Results . We analyzed data for 4729 perinatally HIV-exposed singleton births. Of mothers with prenatal care data, 92% had prenatal care. The overall proportion who received prenatal care and were diagnosed with HIV before delivery was 86% in 1994 to 1996 and 90% in 1997 to 2003. Use of prenatal antiretrovirals among mothers who received prenatal care was 63% in 1994 to 1996 and 82% in 1997 to 2003. From 1994 to 2003, cesarean births among the entire sample increased from 15% to 55%. During 1997 to 2003, the perinatal HIV transmission rate among the entire sample was 7%; 45% of mothers of infected infants had missed opportunities for perinatal HIV prevention. During 1997 to 2003, maternal illicit drug use was significantly associated with lack of prenatal care. Lack of prenatal, intrapartum, and neonatal antiretrovirals; maternal illicit drug use; and low birthweight were significantly associated with perinatal HIV transmission. Conclusions . Interventions for perinatal HIV prevention can successfully decrease HIV transmission rates. Ongoing perinatal HIV surveillance allows for monitoring the implementation of guidelines to prevent mother-to-child transmission of HIV and determining factors that may contribute to perinatal HIV transmission. The perinatal HIV epidemic began in the United States in 1977. Currently, an estimated 6000 to 7000 births occur annually to HIV-infected women. 1 – 3 Beginning in the mid-1990s, the use of antiretroviral therapies to prevent perinatal HIV transmission resulted in a decline in the number of perinatally HIV-infected infants born each year in the United States, from an estimated 1000 to 2000 in the early 1990s to 100 to 200 in 2005. 3 , 4 Successes in prevention of perinatal HIV transmission were first shown in 1994 with the landmark Pediatric AIDS Clinical Trials Group Protocol 076 Study of prenatal, intrapartum, and neonatal treatment with zidovudine 5 , 6 and subsequently with regimens containing prenatal zidovudine in combination with other antiretroviral agents. 7 Short-course antiretroviral therapies were also effective in reducing perinatal HIV transmission. 8 – 13 In 1999, recommendations were made by the American College of Obstetricians and Gynecologists that HIV-infected pregnant women be offered scheduled cesarean delivery for perinatal HIV prevention. 14 The recommendations were refined in 2000 to offer scheduled cesarean delivery for women with HIV RNA levels above 1000 copies/mL, 14 , 15 a level that carries an increased risk of perinatal HIV transmission. 16 – 19 Since the beginning of the perinatal HIV epidemic in the United States, New York City has been at its epicenter. As of 2003, 22% of the cumulative US pediatric AIDS cases were reported from New York City. 20 Since 1988, the New York State Department of Health has tested all newborns for HIV exposure, initially as a blinded serosurvey and since 1997 through the Comprehensive Newborn Screening Program, allowing for identification of all perinatally HIV-exposed infants. 21 , 22 We investigated trends in interventions for perinatal HIV prevention in New York City over a 10-year period.
