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 facilities for diagnosis of infant HIV infection.

SUBJECTS

57 consecutive mother-infant pairs, mainly from central London but also referred from surrounding hospitals.

INTERVENTIONS

Data were collected on mother's country of origin; CD4 count at delivery; plasma HIV RNA copies/ml; mode of delivery; antiretroviral therapy; infant feeding; and HIV infection in infants.

MAIN OUTCOME MEASURES

HIV infection of infants.

RESULTS

The vertical transmission rate was 12% (7 pairs; 95% confidence interval 3% to 22%). All mothers chose not to breast feed. The caesarean section rate was 53% (30/57). Antiretroviral therapy was taken by 68.5% (39/57) of mother-infant pairs. With antiretroviral therapy or caesarean section, or both, transmission occurred in 6% (0% to 13%) of pairs (3/50). During the 24 months of 1994 and 1995, 21% (4/19) of infants were infected with HIV; 7.9% (3/38) were infected over the 19 months January 1996 to July 1997. The caesarean section rate did not change 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 diagnosis of HIV infection acted to reduce the risk of transmission to their infants. Uptake of antiretroviral therapy increased significantly over time, and the caesarean section rate was persistently high.