# Presentation: 739009

## Slide 1

**Notes:**
Changes have occurred in the distribution of transmission categories for the mothers of children who were infected perinatally and in whom AIDS developed. In the 1980s, most of the women who transmitted HIV vertically were exposed to HIV through injection drug use, and a smaller proportion through high-risk heterosexual contact. Since the 1990s, a smaller proportion of women who transmit HIV vertically are exposed to HIV through injection drug use and a larger proportion through high-risk heterosexual contact. It is likely that some proportion of the women without a specified risk factor were also exposed through high-risk heterosexual contact.

## Slide 2

**Notes:**
Since the beginning of the epidemic, the proportional distribution of HIV transmission categories for the mothers of children with perinatally acquired AIDS has changed.From 1997 through 2006, 43% of the mothers were exposed to HIV through high-risk heterosexual contact, and 19% through injection drug use. Thirty seven percent did not specify a transmission category.From 1981 through 1996, a larger proportion (41%) of women were infected through injection drug use, and a smaller proportion (37%) were infected through high-risk heterosexual contact. However, it is likely that some proportion of the women without a specified risk factor were exposed through high-risk heterosexual contact.

## Slide 3

**Notes:**
In 2006, 86 children with AIDS were reported to CDC. Most (86%) of these children acquired HIV infection perinatally, that is, from their mother during pregnancy. Since the beginning of the AIDS epidemic, 9,522 children have been reported with AIDS. Again, most of these children (92%) were infected perinatally. Another 4% acquired HIV from a transfusion of blood or blood products, and another 2% acquired HIV from transfusion because of hemophilia.

## Slide 4

**Notes:**
The estimated number of AIDS cases diagnosed among persons perinatally exposed to HIV peaked in 1992 and has decreased in recent years.The decline in these cases is likely associated with the implementation of Public Health Service guidelines for the universal counseling and voluntary HIV testing of pregnant women and the use of antiretroviral therapy for pregnant women and newborn infants (MMWR 2002;51(No. RR-18)). Other contributing factors are the effective treatment of HIV infections that slow progression to AIDS and the use of prophylaxis to prevent AIDS opportunistic infections among children. 

## Slide 5

**Notes:**
In April 1994, the Public Health Service released guidelines for the use of zidovudine (ZDV) to reduce perinatal HIV transmission; in 1995, recommendations for HIV counseling and voluntary testing for pregnant women were published, and in 2002 recommendations on the use of antiretroviral drugs in pregnant, HIV-infected women were updated. Since then, the proportion of perinatally HIV-exposed or infected children who received ZDV or whose mother had received ZDV has increased markedly. This increase in ZDV use, including receipt by the mother during the prenatal or the intrapartum period and receipt by the neonate, has been accompanied by a decrease in the number of perinatally HIV-infected children and is responsible for the dramatic decline in perinatally acquired AIDS.The data presented here are from the 50 areas (45 states and 5 U.S. dependent areas) with confidential name-based HIV infection surveillance, and may not represent all states in the United States. Perinatal exposure data are from the 33 areas (31 states and 2 U.S. dependent areas) that currently report perinatal exposure to HIV.
In 2006, the following 45 states and 5 U.S. dependent areas conducted HIV case surveillance and reported cases of HIV infection in adults, adolescents, and children to CDC: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, Wyoming, American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands.
In 2006, the following 31 states and 2 U.S. dependent areas reported perinatal exposure to HV infection to CDC: Alabama, Arizona, Arkansas, Colorado, Connecticut, Florida, Georgia, Indiana, Iowa, Kansas, Louisiana, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Jersey, New Mexico, New York, Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, Wyoming, Puerto Rico, and U.S. Virgin Islands.

## Slide 6

**Notes:**
In 2006, a total of 86 AIDS cases were reported in children younger than 13 years of age, a decrease from 93 cases in 2005. Most of these cases were perinatally acquired. New York and Florida reported the largest number of cases. Twenty seven states did not report any pediatric AIDS cases.

## Slide 7

**Notes:**
Since the beginning of the epidemic, nearly 39% of children (<13 years) reported with perinatally acquired AIDS were diagnosed within the first year of life and for 22% within the first 6 months. This distribution could change if more HIV-infected childbearing women become aware of their HIV status and seek medical care early in their infant’s life, when treatment could possibly prevent the progression from HIV infection to AIDS in their children.

## Slide 8

**Notes:**
As of December 31, 2006, a total of 1,116 children in the United States and dependent areas were reported to be living with AIDS.  An additional 2,587 children were reported to be living with HIV infection (not AIDS) from 50 areas (45 states and 5 U.S. dependent areas) that conducted confidential name-based HIV infection case surveillance in 2006. 

## Slide 9

**Notes:**
Certain clinical conditions are used to define AIDS among persons infected with HIV. The most commonly reported conditions for children with AIDS are listed on this slide. From the beginning of the epidemic through 2006, 35% of children with AIDS had a diagnosis of Pneumocystis jirovecii, 23% a diagnosis of lymphoid interstitial pneumonitis, and 21% had recurrent bacterial infections. 

## Slide 10

**Notes:**
The incidence of Pneumocystis jirovecii in children with perinatally acquired AIDS peaks at 4 months of age. The age at diagnosis for the other AIDS-defining conditions is much more evenly distributed during the first 2 years of life. Because Pneumocystis jirovecii occurs early, prophylaxis is recommended for all perinatally HIV-exposed children, beginning at 6 weeks of age. The occurrence of Pneumocystis jirovecii in children may indicate missed opportunities for testing pregnant women, the use of zidovudine or other antiretroviral therapies to prevent transmission, or therapy for HIV-exposed children. CDC has a high-priority initiative to reduce HIV transmission from mothers to children by promoting voluntary prenatal maternal HIV testing (intrapartum if women do not receive prenatal care) and antiretroviral therapy.

## Slide 11

**Notes:**
AIDS has disproportionately affected black (not Hispanic) children in the United States. Although only 15% of children in the United States are black, 73% of children reported with AIDS in 2006 were black. The proportion of cases among white (not Hispanic), Hispanic, and Asian/Pacific Islander, and American Indian/Alaska Native children is lower than the proportion of children of these races/ethnicities in the total population. 

## Slide 12

**Notes:**
Black children had the highest rate (0.7 per 100,000) of AIDS among children in 2006.  Because most pediatric cases of AIDS are attributed to perinatal HIV transmission, these rates also reflect the disproportionate racial/ethnic distribution of HIV and AIDS among black women in the United States.

## Slide 13

**Notes:**
It is important for HIV-infected pregnant women to know their HIV infection status in order to make informed decisions about antiretroviral therapy to reduce perinatal transmission of HIV to their infants. The Public Health Service recommends that all pregnant women be offered HIV counseling and voluntary HIV tests. For children reported to CDC in 2006 as perinatally exposed to HIV, 93% were born to women who were tested before or at the time of birth. For children who were perinatally HIV-infected, 38% of them had a mother who was tested before or at the time of birth; among children diagnosed with AIDS, 38% were born to mothers who were tested before or at the time of birth. An additional 31% of children reported with HIV infection (not AIDS) and 38% of children with AIDS were born to mothers tested after the child’s birth. These data demonstrate that early testing and, therefore, the increased potential for ZDV therapy to prevent transmission can help to reduce HIV transmission to children by their mothers.
In 2006, the following 45 states and 5 U.S. dependent areas conducted HIV case surveillance and reported cases of HIV infection in adults, adolescents, and children to CDC: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, Wyoming, American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands.
In 2006, the following 31 states and 2 U.S. dependent areas reported perinatal exposure to HV infection to CDC: Alabama, Arizona, Arkansas, Colorado, Connecticut, Florida, Georgia, Indiana, Iowa, Kansas, Louisiana, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Jersey, New Mexico, New York, Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, Wyoming, Puerto Rico, and U.S. Virgin Islands.