PERINATAL HIV-INFECTION AND THE EFFECT OF ZIDOVUDINE THERAPY ON TRANSMISSION IN RURAL AND URBAN COUNTIES

Objectives.-To assess health care providers' identification of human i mmunodeficiency virus (HIV)-exposed infants, to ascertain the prevalen ce of transplacental or oral zidovudine treatment among infants expose d to HIV, and to estimate the impact of zidovudine use on perinatal tr ansmission in rural and urban North Carolina. Design.-Survey of North Carolina newborns tested for HIV infection in 1993 and 1994 compared w ith the number of anonymous HIV-positive childbearing women. Setting.- North Carolina hospitals, public health clinics, and private physician s' offices. Main Outcome Measures.-Rates of identification of HIV-expo sed infants and of perinatal HIV-1 transmission, determined by HIV cul ture and polymerase chain reaction testing in the infants. Results:-Th e proportion of HIV-exposed children in North Carolina who were identi fied and tested increased from 60% in 1993 to 82% for all of 1994, and to more than 90% for the last quarter of 1994. The HIV-exposed infant s born in rural counties were more likely to be recognized than those born in urban counties (P<.001). In 1994, most infants were evaluated relatively early in life: 39% by 1 week of age, 63% by 6 weeks, and 76 % by 3 months. Among infants with recognized HIV exposure, transmissio n decreased significantly between 1993 and 1994, from 21% to 8.5%, res pectively (P=.009). After the announcement of the results of AIDS Clin ical Trials Group Protocol 076, zidovudine was given to 75% of HIV-pos itive women who delivered infants in North Carolina, Only 5.7% of infa nts who received any zidovudine became infected, compared with 18.9% o f infants who received no zidovudine (P=.007). Conclusions.-Health car e providers in North Carolina are identifying most of the stale's HIV- seropositive pregnant women, treating them with zidovudine, and testin g their infants soon after birth for HIV infection. The use of zidovud ine in pregnant women and their infants has reduced perinatal HIV tran smission in the state.