| Pregnancy, Pediatrics
and HIV Infection: Guidelines for Your Practice Page 2
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| New Jersey has the highest
proportion of reported cases of AIDS in women in the country. Through June 2002,
12,252 cases of AIDS in women have been reported in New Jersey, accounting for 28% of
adult and adolescent cases reported to the New Jersey Department of Health and Senior
Services. The impact on children has been remarkable. Of 756 cumulative AIDS cases
reported in children through December 2001, 95% have occurred as a result of perinatal HIV transmission. Of 318
children living with HIV infection as of June 2002, 96% acquired HIV infection through
perinatal transmission. |
Scope
of Epidemic Among Women and Children in New Jersey
as of June 2002
12,252 AIDS cases in women reported = 28% of
adult/adolescent cases today
756 cumulative AIDS cases reported in
children
318 children living with HIV infection
New Jersey Department Of Health and Senior
Services
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| When antiretroviral drugs are
not provided during pregnancy, mother-to-child transmission has ranged from 16% to 50%.
This number has changed in North America and Europe. Before introducing the
prenatal use of antiretroviral agents such as zidovudine (AZT) in 1994, the transmission
rate in the United States was 21%. In 1995, after routine use of AZT in pregnancy women,
the rate dropped to 11%. |
Perinatal
Transmission of HIV
Before AZT use = 21%
After AZT use = 11%
Centers for Disease Control, 1996
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| The US Public Health Services
Guidelines were developed in 1994 in response to findings of the Pediatric AIDS Clinical
Trials Groups (PACTG) 076, a randomized, double-blind, placebo-controlled trial that
tested the efficacy of AZT in reducing the risk of maternal-fetal transmission of HIV.1 In pregnant women who had received no prior
treatment with antiretroviral drugs during their pregnancy, AZT reduced the risk of HIV
transmission from mother to infant by approximately two thirds (see Figure below).
Subjects on placebo had a 22.6% transmission rate, whereas subjects in the AZT group had
only a 7.6% transmission rate, representing a 66% reduction in the risk of transmission (P
= <0.001). The study demonstrated that using AZT in women with asymptomatic HIV disease
from the second trimester through delivery and in the neonatal period would decrease the
risk of perinatal transmission. |
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