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Increased Use of Maternal Combination Antiretroviral Therapy and Elective Cesarean Section to Reduce Perinatal HIV Transmission in North Carolina S. A. FISCUS*, A. A. ADIMORA, V. J. SCHOENBACH, J. KENNY, D. A. TRISTRAM, W. LIM, R. MCKINNEY, D. RUPAR, C. WOODS, and C. WILFERT.
Univ. of North Carolina at Chapel Hill, Duke Univ., Durham, NC; and North Carolina Children's AIDS Network Objective: To determine recent trends in the use of combination antiretroviral therapy (ART) and elective C-section among HIV-infected pregnant women in NC and their effects on perinatal transmission.
Methods: Retrospective analysis of 261 infants born to HIV+ women in NC between Jan 1, 1998 and Sept 30, 1999, who had known infection status, ART, and/or delivery history compared with 525 infants with known infection status and ART history born in 1994-1997.
Results: Use of any ART exposure to the infant increased from 62% in 1994 to 99% for the first 9 months of 1999. Maternal combination ART increased from 2% in 1996 to 68% in 1999. Mothers used 15 different combination regimens in 1998 and 10 in 1999. AZT+3TC (49%, 1998; 27%, 1999) and AZT+3TC+NFV (30%, 1998; 49%, 1999) were the most common combination regimens. 87% of women took AZT+3TC with or without some other antiretroviral agent. Elective C-sections increased from 9% in Jan/June 1998 to 43% in 1999. In 1998 and 1999, 50% and 54%, respectively, of HIV-infected women were identified during prenatal testing. We have seen a decrease in the number of HIV-infected infants born in the state - an average of 12/year for 1994-1996 to about 4-6/year for 1997-1999. Since 1998 none of the 36 infants born via elective C-section with known infection status has been infected, but 23/36 (63%) also received combination ART. 8/9 infected infants in 1998-1999 received either no ART (n=3), abbreviated ZDV monotherapy (n=3), or had mothers who did not adhere to the ART regimen (n=2).
Conclusions: Use of combination ART and elective C-sections have increased in NC, accompanied by further reductions in perinatal HIV transmission.
Key Words: AZT+3TC, Cesarean section, perinatal transmissi
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