54
Vol. 66, No. 3 2015
Northeast Florida Medicine
CME
under resourced parts of the world. Conversely, breast
feeding by a HIV infected mother is not recommended
in the United States and other developed countries.
While the number of HIV infected pregnant females
has increased by about 30 percent, from 6000 in 2000
to almost 9000 in 2006, the United States has been suc-
cessful in decreasing MTCT. This success is mostly due
to better systems to diagnose HIV infection in women of
childbearing age, especially pregnant women, and subse-
quent intervention to prevent MTCT. This is probably
one of the most significant public health interventions
in the US, if not the world, in modern history. Despite
great success in the United States, perinatal HIV trans-
mission does still occur. In 2010, 217 children <13 years
were diagnosed with HIV and 162 (75 percent) of those
children contracted their infection as a result of MTCT.
4
By 2009, a cumulative of 10,834 children were diagnosed
with HIV and 88 percent were a result of MTCT.
4
63
percent of those MTCT children were African American.
4
The story of pediatric HIV in 2015 is the story of
prevention of MTCT and is inextricably associated with
HIV infection in females. Although there have been tre-
mendous leaps in the prevention of MTCT, infections
are still being transmitted and challenges remain. Many
barriers result in missed opportunities. Some of these
challenges, according to the CDC, include:
4
1. Primary HIV prevention strategies for females
2.Unintended pregnancies
3. Lack of appropriate prenatal care, prenatal HIV testing,
prenatal antiretroviral medication, Cesarean delivery
when appropriate and avoidance of breast feeding
4.HIV testing
5. Substance abuse
6. Socioeconomic issues
7. Pre-chewing food for infants
8. Limited access to safe conceptionmethods and services
9.Mental health issues
Pediatric HIV in Florida
Of all the reported cases in Florida of HIV infection
in 1987, 11 percent were in women. This number grew
to 29 percent in 2005. In 2014 this figure was 20 per-
cent.
5
When it comes to states with the highest number
of pediatric AIDS cases, the state of Florida, with 1,571
pediatric AIDS cases in 2013, ranks second, after New
York, in the number of pediatric AIDS cases.
6,7
Through
2013, Florida has reported 2,561 cases of pediatric HIV
infection, of which 74 percent were in African Americans
and 95 percent were the result of MTCT.
6,7
The number
of perinatally acquired HIV-infected babies born in
Florida (N=1,208 through 2013) has steadily declined
(91 percent)from a peak of 110 cases in 1993 to 10 cases
in 2013.
6,7
Of the 503 babies known to be born to an
HIV-infected mother in Florida in 2013, 10 (2 percent)
were infected.
6,7
The risk factors for these transmissions include:
1.Mothers who do NOT know their HIV status
prior to birth
2. Inadequate prenatal care (adequate care is defined
as: 5 or more visits, starting by month 4 or earlier),
3.No prenatal antiretroviral therapies (ART)
4.No ART at delivery, and/or
5.Non-caesarean birth
6.No neonatal ART (within the first 6 weeks of the
infant’s life)
7. Breast feeding
8. A mother who is a substance abuser during pregnancy
9. A mother who acquired a STD during pregnancy
10. Issues associated with poverty and limited access
to health care
In Florida, state law requires that healthcare providers
must offer HIV testing to all pregnant patients early and
late in pregnancy. HIV testing should be offered at the
initial visit and then at 36 weeks gestation or after. The
use of an “opt-out” HIV testing strategy in Florida has
increased HIV testing in pregnant women by making it
easier. In Florida there are many sites where HIV testing
can be obtained free of charge. Testing is always confiden-
tial and has the same protection under HIPPA laws as any
other medical condition.
In Jacksonville there is a system of care for HIV-infect-
ed women and children led by the University of Florida
Center for HIV/AIDS Research, Education and Service, in
collaboration with many community and healthcare part-
ners. As a result, MTCT of HIV remains a rare occurrence
and is considered a sentinel event for which UF CARES
conducts an intensive route cause analysis.
Developing this infrastructure and a system of care using
theTesting, Engaging and Retain (TEAR) in caremethodol-
ogy is key to identifying HIV-infected women and bringing
