Perinatal exposure to HIV among children born in Australia, 1982-2006

Objective: To describe the pattern of perinatal HIV exposure and outcomes among children born in Australia, 1982-2006. Design and setting: National surveillance for perinatal HIV exposure. Participants: Women with HIV infection and their perinatally exposed children. Main outcome measures: Trends in the age-standardised rate of perinatal exposure, uptake of interventions by women with an antenatal HIV diagnosis, and rate of mother-to-child transmission. Results: Between 1982 and 2006, there were 354 reported cases of perinatal HIV exposure among children born in Australia. The age-standardised rate of perinatal exposure per 100 000 live births increased from 2.3 (1982-1986) to 5.1 (1991-1998), 9.9 (1999-2002) and 8.3 (2003-2006). Among children whose mother was diagnosed antenatally, the mother-to-child transmission rate declined significantly, from 25% (4/16; 95% Cl, 7%-52%) in 1987-1990 to 5% (4/82; 95% Cl, 1%-12%) in 2003-2006 (P < 0.001). The rate declined from 8% (4/51; 95% Cl, 2%-19%) in 1987-1998 to 1% (2/151; 95% Cl, 0.2%-5%) in 1999-2006 among children whose mother used at least two interventions. Mother-to-child transmission remained high among children born to women diagnosed postnatally (39/87, 45%; 95% Cl, 34%-56%) and to women diagnosed antenatally who used no interventions (7/15, 47%; 95% Cl, 21%-73%). Conclusion: The increasing rate of perinatal exposure and the decreasing rate of mother-to-child transmission among children whose mothers' HIV infection was diagnosed antenatally were temporally associated with use of interventions for minimising mother-to-child transmission. Mother-to-child transmission remained high when the mother's HIV infection was not known during pregnancy.