1. Perinatal HIV Case Series Reports for Births in 2005-2006 Presenter: Elvia Ledezma Texas Department of State Health Services

2. Overview of Infected Children, 2005-2006 In Texas 558 HIV+ women delivered in 2005- 2006 13 children are HIV+ 2005-5 infected 2006-8 infected 2.3% of all births for this period are infected

3. Infected children born to HIV positive women living outside of Houston

4. Case #1 Demographics Age 37; Single; Black/ Non-Hispanic; 4 previous pregnancies HIV/STD History No STDs; + HIV test 14 years prior; AIDS one month after HIV diagnosis Mode of Exposure-IV Drug Use Pregnancy Limited Prenatal Care (1 to 2 visits) No ART (non-compliant prior to pregnancy) Labor and Delivery Receipt of ART Elective C-Section (Viral Load-933,000 copies/mL ) Toxicology Screen Positive for Cocaine (mother and infant) Birth History Receipt of ART 35 weeks gestation and 2075 grams in weight No Breastfeeding Noted and Unknown if received PCP prophylaxis

5. Case #2 Demographics Age 19; Single; Black/ Non-Hispanic; 3 previous pregnancies HIV/STD History No STDs; 1 st + HIV test at delivery (EIA, WB); AIDS 7 months after delivery Mode of Exposure- Heterosexual Contact Pregnancy No Prenatal Care No ART Labor and Delivery No ART C-section of Unk. Type Toxicology Screen Positive for Cocaine (mother only) Birth History Twins Receipt of ART 4 days after delivery 40 weeks gestation and 2329 grams in weight Unknown if Breastfed or if received PCP prophylaxis

6. Case #3 Demographics Age 34; Single; Hispanic; No previous pregnancies HIV/STD History STDs present at delivery; + HIV test 9 years prior; AIDS diagnosis at delivery Mode of Exposure- Heterosexual Contact Pregnancy No prenatal care reported No ART Labor and Delivery Receipt of ART Elective C-Section Toxicology Screen Positive for Cocaine (mother ) Birth History Receipt of ART 39 weeks gestation and 3585 grams in weight Unknown if Breastfed or if received PCP prophylaxis

7. Case #4 Demographics Age 27; Single; Black/Non-Hispanic; No previous pregnancies HIV/STD History STDs present at delivery; + HIV test 2 years prior Mode of Exposure- Heterosexual Contact Pregnancy No prenatal care reported No ART CD4 Count (156) and Viral Load (1800 copies/ml) Labor and Delivery Receipt of ART Elective C-Section Negative Toxicology Screen Birth History Receipt of ART 35 weeks gestation and 2315 grams in weight No breastfeeding and unknown if received PCP prophylaxis

8. Case #5 Demographics Age 28; Single; White/Non-Hispanic; 1 previous pregnancy HIV/STD History No STDs; -HIV antibody test 6 months prior to deliv.; + HIV test 2 days after (PCR, EIA, WB) Mode of Exposure- Not specified Pregnancy Prenatal began in 2 nd Trimester (10 visits) No ART Labor and Delivery No ART Vaginal Delivery Indication of drug use but no toxicology screen done Birth History Receipt of ART (2 days after birth) 39 weeks gestation and 3190 grams in weight No breastfeeding and unknown if received PCP prophylaxis

9. Case #6 Demographics Age 30; Married; Black/Non-Hispanic; 3 previous births HIV/STD History No STDs; + HIV 2 months prior to delivery Mode of Exposure- Not specified Pregnancy Prenatal began in 3 rd Trimester (1 visit) No ART Labor and Delivery Vaginal Delivery prior to arrival at the hospital No ART Positive Toxicology Screen (mother and child) Viral Load (34,500 copies/ml)-after delivery Birth History Receipt of ART 40 weeks gestation and 2627 grams in weight No breastfeeding and unknown if received PCP prophylaxis

10. Case #7 Demographics Age 26; Single; Black/Non-Hispanic; Unknown pregnancy history HIV/STD History No STDs; + HIV test 6 years prior; AIDS diagnosis during pregnancy Mode of Exposure- Heterosexual Contact Pregnancy Prenatal began in 2 rd Trimester (3 visits) Receipt of ART CD4 (125) and Viral Load (49,800 copies/ml) Labor and Delivery Vaginal Delivery Receipt of ART Positive Toxicology Screen (mother and child) Birth History Receipt of ART 35 weeks gestation and 2070 grams in weight No breastfeeding and unknown if received PCP prophylaxis

11. Case #8 Demographics Age 36; Single; White/Hispanic; 1 previous birth HIV/STD History No STDs; + HIV test at delivery (EIA and WB) Mode of Exposure- None specified Pregnancy No prenatal care No ART Labor and Delivery Vaginal Delivery No ART No indication of substance use and no toxicology screen Viral Load (750,000 copies/ml) Birth History Receipt of ART 38 weeks gestation and 3096 grams in weight No breastfeeding and unknown if received PCP prophylaxis

12. Two Cases with Unknown Mode of Exposure Due to limited information on the mother the children's mode of exposure is classified as “Pediatric Other/Undetermined” Unknown locations of birth (Potential births outside of the U.S.) Mothers are of Hispanic decent Both children were adopted and are living in Texas

13. Demographics of HIV+ Women Delivering an Infected Child, 2005-2006 Age Range: 62.5% of women were 25 to 34 years of age Marital Status: 87.5% were single Race/Ethnicity: 62.5% Black; 25% Hispanic; 12.5% White More than half had a previous pregnancy Average of 2 pregnancies for these 5 women

14. HIV/STD History of Women Delivering an Infected Child, 2005-2006 STD at Delivery 25% record of an infection Mode of Exposure 25% IV 50% Heterosexual Contact

15. HIV/STD History of Women Delivering an Infected Child, 2005-2006 Timing of HIV Test 50% prior to delivery (Avg-8 years prior to delivery) 12.5% during pregnancy 25% at delivery 12.5% after delivery AIDS Diagnosis 25% diagnosed during pregnancy or at delivery 25% diagnosed after delivery

16. Overview of Women Delivering an Infected Child, 2005-2006 Only half of women received prenatal care Limited prenatal care visits (Range 1-10) 87.5% did not receive ART during pregnancy Only 50% received ART during delivery

17. Overview of Women Delivering an Infected Child, 2005-2006 100% received ART neonatally 25% of children unknown if breastfed 62.5% had a positive toxicology screen

18. Conclusion EPS  Texas Perinatal Stats  Case Reports Missed opportunity challenges Lack of prenatal care Lack of ART during pregnancy Timing of HIV test results Assure medical information is available Prevention recommendations

19. Discussion/Comments

20. Contact Information Elvia Ledezma, MPH Epidemiologist Texas Department of State Health Services (512)-533-2045 elvia.ledezma@dshs.state.tx.us