A prospective ten year surveillance study of perinatally transmitted HIV infection in Barbados

ABSTRACT

OBJECTIVE: To analyze the result of the ten years surveillance for the perinatal transmission of Human Immunodeficiency Virus (HIV) between 1990 and 1999,in Barbados. DESIGN AND METHODS: All babies born to HIV-positive mothers were enrolled at birth. They were followed up to 18 months of age with ELISA testing for HIV antibodies, subsequent follow-up being limited to children who remained ELISA positive, and thus HIV-infected. Perinatal history, clinical and investigative findings at follow-up were recorded. RESULTS: 180 babies were born to HIV-positive mothers during 1990-1999. Antenatal HIV screening has increased from one percent in 1990 to >80 percent of pregnant women during 1997-99. The prevalence of HIV positivity among pregnant women has stabilized around 1 percent since 1996. The incidence of babies born to HIV positive mothers has increased from 3.18 (in 1990) to 9.21 per thousand live births in 1999. More babies with low birth weight (15.4 percent) and intra-uterine growth retardation (8.3 percent) were seen among babies exposed to HIV, compared to the general population and these conditions were more frequent among babies who did not recieve prophylactic zidovudine (19.4 percent) and 12.9 percent, respectively) than in those who did (12.8 percent, and 5.3 percent, respectively). The rate of perinatal HIV transmission declined from 34.9 percent during 1990-95 to 4.8 percent during 1996-99 with Zidovudine. The majority (65.9 percent) of fathers were unaware of the mother's HIV-positive status and most (78.9 percent) repeat pregnancies in HIV-positive mothers were by different fathers. CONCLUSION: The incidence of babies born to HIV-positive mothers has been increasing. There has been a significant reduction in the rate of perinatal HIV transmission associated with the use of prophylatic zidovudine. Social circumstances surrounding perinatal HIV transmission need immediate attention in order to reduce rate of perinatal transmission any further. (Au)