REVIEW OF UPTAKE OF INTERVENTIONS TO REDUCE MOTHER-TO-CHILD TRANSMISSION OF HIV BY WOMEN AWARE OF THEIR HIV STATUS

Objectives: To examine the change in uptake of interventions to reduce transmission of HIV from mothers to infants from January 1994 to July 1997. Design: Review of mother-infant pairs who presented for infant diagnosis of HIV infection. Setting: Central London hospital with faci lities for diagnosis of infant HIV infection. Subjects: 57 consecutive mother-infant pairs, mainly from central London but also referred fro m surrounding hospitals. Interventions: Data were collected on mother' s country of origin; CD4 count at delivery; plasma HIV RNA copies/ml; made of delivery; antiretroviral therapy; infant feeding; and HIV infe ction in infants. Main outcome measures: HIV infection of infants. Res ults: The vertical transmission rate was 12% (7 pairs; 95% confidence interval 3% to 22%). All mothers chose not to breast feed, The caesare an section rate was 53% (30/57). Antiretroviral therapy was taken by 6 8.5% (39/57) of mother-infant pairs. With antiretroviral therapy or ca esarean section, or both, transmission occurred in 6% (0% to 13%) of p airs (3/50), During the 24 months of 1994 and 1995, 21% (4/19) of infa nts were infected with HIV; 7.9% (3/38) were infected over the 19 mont hs January 1996 to July 1997. The caesarean section rate did not chang e over these periods. Use of antiretroviral therapy increased from 31. 5% (6/19) to 86.8% (33/38) (P < 0.0001). Conclusion: Women with a diag nosis of HIV infection acted to reduce the risk of transmission to the ir infants. Uptake of antiretroviral therapy increased significantly o ver time, and the caesarean section rate was persistently high.