Reconsidering the Number of Women With HIV Infection Who Give Birth Annually in the United States

Abstract

Objectives: The annual number of women with HIV infection who delivered infants in the United States was estimated to be 8700 in 2006. An accurate, current estimate is important for guiding perinatal HIV prevention efforts. Our objective was to analyze whether the 2006 estimate was consistent with the number of infants with HIV infection observed in the United States and with other data on perinatal HIV transmission.

Methods: We compared the number of infants born with HIV in 2015 (n = 53) with data on interventions to prevent perinatal HIV transmission (eg, maternal HIV diagnosis before and during pregnancy and prenatal antiretroviral use). We also estimated the annual number of deliveries to women living with HIV by using the number of women of childbearing age living with HIV during 2008-2014 and the estimated birth rate among these women. Finally, we determined any changes in the annual number of infants born to women with HIV from 2007-2015, among 19 states that reported these data.

Results: The low number of infants born in the United States with HIV infection and the uptake of interventions to prevent perinatal HIV transmission were not consistent with the 2006 estimate (n = 8700), even with the best uptake of interventions to prevent perinatal HIV transmission. Given the birth rate among women with HIV (estimated at 7%) and the number of women aged 13-44 living with HIV during 2008-2014 (n = 111 273 in 2008, n = 96 363 in 2014), no more than about 5000 women with HIV would be giving birth. Among states consistently reporting the annual number of births to women with HIV, the number declined about 14% from 2008 to 2014.

Conclusion: The current annual number of women with HIV infection delivering infants in the United States is about 5000, which is substantially lower than the 2006 estimate. More accurate estimates would require comprehensive reporting of perinatal HIV exposure.

Keywords: HIV; birth; delivery; pregnancy; women.

Figure.

Estimating the number of newborns with HIV under “basic” and “optimal” uptake of preventive interventions, based on the number of women with HIV giving birth, United States, 2008-2014. This figure illustrates a method to validate an estimated number of women with HIV delivering infants against a known number of infants born with HIV infection in a given year, incorporating what is known about women’s knowledge of their HIV status before pregnancy, the rate of prenatal HIV testing, the uptake of antiretrovirals (ARVs) for maternal treatment and perinatal prophylaxis, and the mother-to-child HIV transmission rates when ARVs are used or not used. For each factor, there is a “basic” and an “optimal” value. The basic case used established data from the largest sources available (eg, the Centers for Disease Control and Prevention’s Enhanced Perinatal Surveillance). The optimal case used best-case estimates (ie, estimates of available data, the best adherence to recommended practice), most of which were from states or cities. Of the women with HIV delivering infants in a given year, the number of infants with infection depends on the proportions of women with various combinations of these values. The 5 “estimates” in the bottom row of boxes are those infants. For example, estimate 1 contains the number of infants with infection born to mothers whose HIV infection status was known before pregnancy and who took ARVs. The total number of infants with infection is the sum of the numbers in the 5 boxes. In this case, the number of infants born with infection is based on 5000 women with HIV with live births in a particular year.