Perinatally Exposed Infants

As of December 31, 2001, an estimated 1,577 infants have been born in Louisiana to women with HIV. Of these infants, 16% were infected with HIV perinatally (i.e., through mother-to-child transmission). Each year, perinatal transmission accounts for most of the pediatric HIV cases in Louisiana. In 2001, perinatal transmission accounted for 100% of all HIV cases in children under the age of 13.

The number of infants born annually to HIV-infected mothers has steadily increased as more women are living with HIV/AIDS. In 2001, after delays in reporting were accounted for, approximately 184 HIV-exposed infants were born in Louisiana (Figure 41). Although the numbers of HIV-exposed infants has increased, perinatal transmission rates have decreased (See Figure 12); both of these trends have been due in large part to the increased use of antiretroviral therapy. In 2001, 94% of HIV-positive mothers had received antiretroviral therapy during pregnancy or during labor and delivery. (Note: This percentage may be an overestimate of antiretroviral use because not all cases of HIV exposure have been reported to the Office of Public Health. Cases not yet reported are more likely to be associated with unknown infection status at the time of delivery, hence, with the absence of antiretroviral medications for the mother.)

Figure 41: Antiretroviral Therapy (ART) During Pregnancy or Labor and Delivery
Louisiana, 1993-2001

Nearly half (41%) of the women with HIV who gave birth in recent years have been 20–24 years of age (Figure 42). Almost all (93%) were black.

Figure 42: Infants Born to Mothers with HIV Infection, by Age and Race/Ethnicity (N=498)
Louisiana, 1999-2001

Among mothers whose mode of HIV exposure has been identified, most had contracted HIV infection through heterosexual activity; approximately 1 in 5 had contracted HIV through injection drug use (data not shown). HIV infection in nearly all mothers (96%) had been diagnosed before delivery, which maximizes the opportunities for antiretroviral intervention (Figure 43).

Figure 43: Infants Born to Mothers with HIV Infection, by Timing of Diagnosis for Mother (N=498)
Louisiana, 1999-2001

However, HIV infection had been diagnosed in 59% of the mothers before they became pregnant. Although some of these pregnancies may represent informed choices, others may represent continued unprotected sexual activity and the need for appropriate prevention interventions.

Geographically, most births to HIV-positive mothers occur in Regions 1 and 2 (the New Orleans and Baton Rouge regions); however, births to HIV-positive mothers have occurred in all parts of the state (Figure 44).

Figure 44: Infants Born to Mothers with HIV Infection, by Region (N=655)
Louisiana, 1997-2000

Figure 45 highlights HIV prevalence among black women who gave birth, as most HIV-exposed births (93%) occur in this population. Although Region II accounts for a smaller number of births to HIV-infected mothers than Region I (Figure 44), births to HIV-positive mothers in Region II made up a much higher proportion of all live births to black women than anywhere else in the state. In 2000, in the Baton Rouge region, approximately 1 in 63 black women aged 25–29 who gave birth had HIV infection.

Figure 45: Percentage of Live Births to HIV-Infected Black Women
Louisiana, 2000

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