Departments of Pediatrics.
Medicine.
Pediatrics. 2024 Nov 1;154(5). doi: 10.1542/peds.2023-065371.
The perinatal transmission of HIV is preventable through a regimen that includes testing of all pregnant individuals, antiretroviral treatment (ART) for the pregnant individual, prophylactic or preventative ART for the infant, and cesarean section delivery for mothers with HIV viremia at the time of delivery. Under this protocol, the United States has seen a significant decline in the perinatal transmission of HIV and achieved a perinatal HIV transmission rate of 0.9% in 2019. However, despite this progress nationally and after zero transmissions in 2021, Maryland recorded 6 cases of perinatal HIV diagnoses in 2022. Each of the 3 major referral centers for pediatric HIV patients in Maryland reported 2 new cases in 2022. A root cause analysis of the cases identified risk factors including delayed entry into perinatal and HIV care, premature birth, maternal adherence challenges in the setting of substance use and other adverse social determinants of health, and failure to diagnose maternal HIV infection in a timely way. All patients were successfully linked to care and initiated on ART. Multiple factors contributed to the 2022 increase in cases of perinatal HIV in Maryland. To achieve and then sustain the elimination of perinatal HIV transmission, the constancy of systems that eliminate barriers for all pregnant people to access testing, prevention, and treatment is critical.
围产期 HIV 传播是可以预防的，方法是对所有孕妇进行检测，对孕妇进行抗逆转录病毒治疗（ART），对婴儿进行预防性或预防型 ART，以及对 HIV 病毒血症孕妇进行剖宫产。根据这一方案，美国围产期 HIV 传播率显著下降，2019 年达到 0.9%。然而，尽管全国范围内取得了这一进展，并且 2021 年实现了零传播，但马里兰州在 2022 年仍记录了 6 例围产期 HIV 诊断病例。马里兰州 3 家主要儿科 HIV 患者转介中心均报告了 2022 年的 2 例新病例。对病例的根本原因分析确定了一些风险因素，包括围产期和 HIV 护理的延迟进入、早产、药物滥用和其他不良健康社会决定因素下的母亲遵医嘱困难，以及未能及时诊断母亲的 HIV 感染。所有患者都成功地接受了治疗并开始接受 ART 治疗。多种因素导致马里兰州 2022 年围产期 HIV 病例增加。为了实现并维持消除围产期 HIV 传播的目标，消除所有孕妇获得检测、预防和治疗的障碍的系统的稳定性至关重要。
