Daily Digests: Division of HIV/AIDS Prevention Science
This digest summarizes the Division of HIV/AIDS Prevention science presented on Thursday, July 26.
Cost-effectiveness of more frequent HIV screening of MSM in the US
Lead Author: Angela Hutchinson
Summary: This study, presented by Angela Hutchinson, PhD, in CDC’s Division of HIV/AIDS Prevention, assessed the cost-effectiveness of HIV screening for men who have sex with men (MSM) every 3-6 months compared to annually. Using a published mathematical model of HIV transmission, the authors evaluated screening intervals for 10,000 MSM aged 14-64 for number of HIV infections avoided due to status awareness and for treatment costs associated with prevented infections. HIV incidence was estimated at 1.27% for MSM, and each HIV infection averted was estimated to save $391,000 in lifetime treatment costs. Compared to annual screening, HIV testing every 6 months, and testing every 3 months, compared to every 6 months, averted additional HIV transmissions and was cost-saving. Authors conclude that screening of MSM every 3 months to 6 months is cost-effective and cost-saving and suggest that the screening recommendations for MSM should be reexamined in light of the economic evidence.
Relevance: In the United States, MSM are the group most affected by HIV. More frequent testing could allow more MSM to learn of their HIV infections early, thus allowing individuals to take measures to protect their own health as well as reduce their risk of transmitting the virus to their partners.
HIV Seroconversion During Pregnancy and Mother-to-Child HIV Transmission: Data from the Enhanced Perinatal Surveillance Project, United States, 2005-2010
Lead Author: Sonia Singh
Summary: Dr. Singh and her colleagues examined the number of HIV-positive women who seroconverted during pregnancy (vs. prior to pregnancy), and the associated rate of mother-to-child HIV transmission (MTCT), using data from CDC's Enhanced Perinatal Surveillance. Among the 10,308 HIV-positive women who had live births from 2005-2010 in 15 U.S. areas, 1.2% (124) seroconverted during pregnancy, 70.2% (7,235) seroconverted prior to pregnancy, and 28.6% (2,949) were not able to be classified. Researchers noted a statistically significant 25% annual increase in women who seroconverted during pregnancy (CI:12.3% - 39.1%) and found that while MTCT occurred in only 2% of births overall, it occurred eight times more frequently among women who seroconverted during pregnancy (12.9% vs. 1.6%; Z=9.3, p<0.0001). The authors suggest that efforts to consistently conduct early prenatal HIV testing, along with repeat third-trimester testing, should be enhanced to ensure provision of MTCT interventions.
Relevance: Mother-to-child HIV transmission (MTCT) has been one of the great successes of HIV prevention in the United States over the past decades. In the early 1990s, over 1,500 infants were born annually with HIV acquired from their mothers. That number has fallen to under 200 annually. In 2006, CDC published “Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings.” These recommendations called for routine opt-out HIV screening for all pregnant women, with repeat HIV screening in the third trimester for women who meet 1 or more of 4 criteria (for example, women at high risk and women who receive health care in jurisdictions with elevated rates of HIV infection among women). Women whose HIV status is unknown at the time of labor should be offered opt-out screening with a rapid HIV test. This study highlights a significant increase in HIV seroconversion during pregnancy, a situation that could be detected through HIV testing during the third trimester or at the time of labor and delivery, when efforts can be made to reduce the risk of infection for the newborn and to protect the health of the mother. Antiretroviral therapy administered to the mother during pregnancy, labor and delivery, and also to the newborn, as well as elective cesarean section for women with high viral loads (more than 1,000 copies/ml), can reduce the rate of perinatal HIV transmission to 2% or less. If medications are started during labor and delivery, the rate of perinatal transmission can still be decreased to less than 10%.
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