ARE WE CLOSE TO ELIMINATION OF PERINATAL HIV INFECTION IN CANADA?

SM King¹, N Lapointe², J Forbes³, L Samson⁴, W Vaundry⁵, J Singer⁶, SE Read¹, Canadian Pediatric AIDS Research Group (CPARG)
¹The Hospital for Sick Children; ⁶Canadian HIV Trials Network and the Universities ¹of Toronto; ²de Montreal; ³of British Columbia; ⁴of Ottawa; ⁵of Alberta; ⁶of Manitoba

Objectives: To evaluate whether strategies to prevent perinatal HIV transmission have been successful in Canada.
Methods: The Canadian Perinatal HIV surveillance program, started in 1992, is an active surveillance program in which pediatric centers and HIV clinics where HIV-exposed or -infected infants receive care, provide a yearly update on their perinatal cases. Information collected includes: maternal data – risk factors for HIV acquisition, country of birth, ethnicity and antiretroviral therapy (ART) in pregnancy; infant data – place and date of birth, infant’s ART and HIV outcome. Data is reported to December 2001.
Results: The cumulative number of indentifed births to HIV-positive mothers is 1336 and was 139 in 2001. The number of infected infants identified for each birth-year for the last decade are 31, 29, 35, 24, 30, 8, 12, 12, 4 and 6, respectively. Through those years the proportion of the mother who have been on ART in pregnancy increased from 47% to 88%. The cumulative number of infected infants is 394, of whom 9 infants were born to mothers who were on any ART. Of those who had been on ART in pregnancy, 36%, 20% and 44% were on mono, dual, and triple or quadruple ART respectively.
Conclusions: The strategies for prevention of perinatal HIV transmission in Canada have been successful in reducing the number of perinatal infected children but a significant number continue to occur. When used, ART is highly effective for prevention of perinatal transmission. Therefore, further reduction of perinatal HIV infection in Canada, requires an increase in HIV testing of pregnant women so that a higher proportion of women who are pregnant and HIV-postive can have access to HIV care.