HIV/AIDS Perinatal Surveillance
2002
Minnesota Department of Health
HIV/AIDS Surveillance System
Background



This slide set describes births to HIV-infected women in
Minnesota by person, place, and time.
The slides rely on data from HIV/AIDS cases diagnosed and
infants exposed through 2002 and reported to the Minnesota
Department of Health (MDH) HIV/AIDS Surveillance System.
Some limitations of surveillance data:
 Data do not include HIV-infected persons who have not been
tested for HIV
 Data do not include persons whose positive test results have
not been reported to the MDH
 Data do not include children whose perinatal HIV exposure
has not been reported to MDH
 Case numbers for the most recent years may be
undercounted due to delays in reporting
Introduction

Since 1982, there have been 280 births to women living with HIV/AIDS in Minnesota.

Of these, 35 (12.5%) children have been diagnosed with HIV/AIDS, 172 (61.4%) are
seroreverters*, and 73 (26.1%) have an indeterminate HIV status†.

In 1994 and 1995, the U.S. Public Health Service (PHS) made recommendations for
universal HIV testing of all pregnant women, and the use of zidovudine (ZDV‡) to
prevent mother-to-child (MTC) transmission of HIV.

Rates of MTC HIV transmission in Minnesota have decreased since the publication
of these PHS recommendations. During the years 1982-1994 the rate of MTC
transmission was 25%, decreased to 10% during 1995-1999, and was 2% in
2000-2002.

A total of 10 children acquired HIV perinatally in Minnesota since 1996.
* At the time of birth an infant may test positive for HIV due to the presence of antibodies from the HIV-infected mother. If the infant does not go on to
develop infection, s/he will eventually test negative for HIV antibodies and is said to be a “seroreverter.”
An indeterminate status means the Minnesota Department of Health (MDH) is unaware of the child’s status (either due to no follow-up HIV test or more
likely the result of the negative follow-up test was not reported to MDH).
‡ Zidovudine (ZDV) is an anti-HIV drug.
†
Births to HIV-Infected Women and Number of Perinatal HIV Infections*
by Year of Birth, Minnesota 1990-2002
40
Births
HIV Infections
Number of Cases
30
20
Rate of Perinatal Transmission
for years 2000-2002 = 2%
10
0
1990
1991
1992
1993
1994
1995 1996
Year
1997
1998
1999
2000
2001
2002
* HIV or AIDS at first diagnosis for a child exposed to HIV during mother’s pregnancy, at birth, and/or during breastfeeding.
NOTE: Reporting of births is known to be incomplete. During 2001 an Enhanced Perinatal Surveillance Project (EPS) Project was undertaken and
identified 19 of the 37 births reported in 2001.
Data Source: Minnesota HIV/AIDS Surveillance System
Enhanced Perinatal Surveillance Project
Time of Mother’s Diagnosis for
Perinatal HIV Infections, Minnesota 1996 -2002
Time of HIV Diagnosis
Before pregnancy*
During pregnancy, before
delivery †
At delivery
After birth
Total
Number (%)
2 (20)
1 (10)
2 (20)
5 (50)
10 (100)
* These two mothers refused HIV testing and neither revealed her HIV status to her health care provider(s) – therefore
no antiretroviral therapy was provided to mother or child.
† Mother did not comply with her medication regimen during pregnancy.
Data Source: Minnesota HIV/AIDS Surveillance System
Enhanced Perinatal Surveillance Project
Births to HIV-Infected Women and Perinatal HIV Infections
by Mother’s Race/Ethnicity, Minnesota 1996-2002
Births to HIV-infected Women
(n=168)
Afr Amer
36%
White
30%
Amer Indian
5%
Asian
2%
Hispanic
6%
Afr born
21%
Perinatal HIV Infections
(n=10)
Afr Amer
30%
Hispanic
20%
White
10%
Asian
10%
Afr born
30%
Amer Ind = American Indian Afr Amer = African American (Black, not African-born) Afr born = African-born (Black, African-born)
Data Source: Minnesota HIV/AIDS Surveillance System
Enhanced Perinatal Surveillance Project
Births to HIV-Infected Women and Perinatal HIV Infections
by Mother’s Region of Birth, Minnesota 1996-2002
Births to HIVInfected Women
No. (%)
Perinatal HIV
Infections
No. (%)
United States
115 (69)
5 (50)
Africa
32 (19)
2 (20)
Asia
4 (2)
1 (10)
Caribbean/Mexico/
South America
8 (5)
2 (20)
159* (100)
10 (100)
Mother’s Region
of Birth
Total
* Excludes 9 births to women with an unknown region of birth.
Data Source: Minnesota HIV/AIDS Surveillance System
Enhanced Perinatal Surveillance Project
Births to HIV-Infected Women and Perinatal HIV Infections
by Mother’s Race/Ethnicity, Minnesota 1996-2002
Births to HIV
Infected Women
No. (%)
Perinatal HIV
Infections
No. (%)
White
51 (30)
1 (10)
African-American
60 (36)
3 (30)
African-born
35 (21)
3 (30)
Hispanic
10 (6)
2 (20)
American Indian
8 (5)
0 (0)
Asian
4 (2)
1 (10)
Total
168 (100)
10 (100)
Mother’s
Race/Ethnicity
Data Source: Minnesota HIV/AIDS Surveillance System
Enhanced Perinatal Surveillance Project
Births to HIV-Infected Women and Perinatal HIV Infections
by Mother’s Region of Birth, Minnesota 1996-2002
Births to HIV-infected Women
(n=168)
United
States
69%
Perinatal HIV Infections
(n=10)
United
States
50%
Africa
20%
Unknown
5%
Asia
10%
Car/Mex/S. Asia
America
2%
5%
Africa
19%
Car/Mex/S.
America
20%
Car = Caribbean, Mex = Mexico, S. America = South America
Data Source: Minnesota HIV/AIDS Surveillance System
Enhanced Perinatal Surveillance Project
Births to HIV-Infected Women and Perinatal HIV Infections
by Mother’s Residence, Minnesota 1996-2002
Births to HIV-infected Women
(n=168)
Minneapolis
30%
Greater MN
12%
Perinatal HIV Infections
(n=10)
St. Paul
15%
St. Paul
20%
Minneapolis
30%
Suburban
43%
Greater MN
10%
Suburban
40%
Suburban = Seven-county metro area including Anoka, Carver, Dakota, Hennepin (except Minneapolis), Ramsey (except St. Paul), Scott, and Washington
counties. Greater MN = All other Minnesota counties, outside the seven-county metro area.
Data Source: Minnesota HIV/AIDS Surveillance System
Enhanced Perinatal Surveillance Project
Compliance with PHS Guidelines among
Cases of Perinatal HIV Infection in Minnesota 1996-2002

In 5 of 10 cases of perinatal HIV infection, the mother was not diagnosed
with HIV infection until after the child’s birth.
 4 of the 5 mothers diagnosed after the child’s birth received prenatal
care.

Among the 5 cases of perinatal HIV infection whose mothers were
diagnosed with HIV at or prior to birth, 3 received prenatal care.
 In the 2 cases without prenatal care, both infants were treated with ART
 Of the 3 cases with prenatal care:
1 mother received ART, but did not consistently take the medications
2 mothers refused HIV testing and neither revealed her HIV status to
her health care provider(s) – no ART was provided to mother or child


PHS = Public Health Service
Data Source: Minnesota HIV/AIDS Surveillance System
Enhanced Perinatal Surveillance Project
Enhanced Perinatal Surveillance
Project Summary
Enhanced Perinatal HIV Surveillance (EPS) Project

Initiated in summer of 2001.

Project goals:
 To improve completeness and accuracy of perinatal HIV/AIDS
surveillance records, and
 To evaluate implementation of 1994/1995 PHS* guidelines related to
universal HIV testing of pregnant women and zidovudine treatment to
prevent perinatal transmission.

All Minnesota births to HIV-infected women between 1/1/1999 and
8/31/2001 were included.

For each birth, medical care and vital statistics records were abstracted;
including additional detail not collected in routine HIV/AIDS surveillance.

The project identified 70 eligible births in Minnesota and data collection was
completed in June 2002.
Data Source: Minnesota HIV/AIDS Surveillance System
Enhanced Perinatal Surveillance Project
Minnesota EPS Project: Mothers’ Demographics
January 1999 – August 2001
Race/Ethnicity
(n = 70)
Region of Birth
(n= 70)
United
States
70%
Afr Amer
38%
White
29%
Asian
3%
Amer Ind
3%
Hispanic
6%
Afr born
21%
Unknown
1%
Other
9%
Africa
20%
Amer Ind = American Indian Afr Amer = African American (Black, not African-born) Afr born = African-born (Black, African-born)
Data Source: Minnesota HIV/AIDS Surveillance System
Enhanced Perinatal Surveillance Project
Minnesota EPS Project: Mothers’ Demographics
January 1999 – August 2001
Place of Residence (at birth)
Number
Percent
Minneapolis
St. Paul
Suburban*
Greater Minnesota*
18
14
31
7
(26)
(20)
(44)
(10)
Total
70
100
* Suburban = Seven-county metro area including Anoka, Carver, Dakota, Hennepin (except Minneapolis), Ramsey (except St. Paul), Scott,
and Washington counties. Greater MN = All other Minnesota counties, outside the seven-county metro area.
Data Source: Minnesota HIV/AIDS Surveillance System
Enhanced Perinatal Surveillance Project
Minnesota EPS Project: Mothers’ Demographics
January 1999 – August 2001
AGE (at delivery)
Number
Percent
< 20
20 - 24
25 - 29
30 - 34
35 +
5
18
18
20
9
(7)
(26)
(26)
(28)
(13)
Total
70
(100)
Data Source: Minnesota HIV/AIDS Surveillance System
Enhanced Perinatal Surveillance Project
Minnesota EPS Project: Mothers’ Demographics
January 1999 – August 2001 (n = 70)
Marital Status
Number
Percent
Single
Married
Separated / Divorced
Unknown
39
26
4
1
(56)
(37)
(6)
(1)
Mode of Transmission
Number
Percent
8
46
4
2
14
(11)
(66)
-(3)
(20)
Injection Drug User
Heterosexual (total)
Heterosexual w/ IDU
Other
Unspecified
Data Source: Minnesota HIV/AIDS Surveillance System
Enhanced Perinatal Surveillance Project
Minnesota EPS Project: Mother’s Clinical Status by Time of Diagnosis
January 1999 – August 2001 (n = 70)
Time of Mother’s Diagnosis
Before
Pregnancy
During
Pregnancy
At Time of
Delivery
Clinical Status
No.
%
No.
%
No.
%
HIV, not AIDS
28
(76)
28
(94)
1
(33)
AIDS: CD4 < 200 uL
7
(19)
2
(6)
0
(0)
AIDS: Opp. illness
2
(5)
0
(0)
0
(0)
Unknown
0
(0)
0
(0)
2
(67)
Opp. Illness = Opportunistic illness
Data Source: Minnesota HIV/AIDS Surveillance System
Enhanced Perinatal Surveillance Project
Minnesota EPS Project: Prenatal Care and
Antiretroviral Therapy (ART) by Time of Mother’s Diagnosis
January 1999 – August 2001 (n =70)
Prenatal Care
ART Prior to
Pregnancy
ART During
Pregnancy
Time of Diagnosis
Yes
No
Yes
No
Yes
No
Yes
No
Before Pregnancy
36
1
30
7
36
1
36
1
During Pregnancy
30
0
0
30
30
0
28
2
At Time of Delivery
1
2
0
3
0
3
0
3
Data Source: Minnesota HIV/AIDS Surveillance System
ART During
Labor/Delivery
Enhanced Perinatal Surveillance Project
Minnesota EPS Project: Birth Characteristics
January 1999 – August 2001 (n = 70)
Type of Birth
Single
Twin
Mode of Delivery
Vaginal
Elective C-section
Non-Elective C-section
Unknown
Data Source: Minnesota HIV/AIDS Surveillance System
Number
Percent
64
6
(91)
(9)
Number
Percent
39
22
8
1
(56)
(31)
(11)
(1)
Enhanced Perinatal Surveillance Project
Minnesota EPS Project: Birth Characteristics: C-section* Deliveries
January 1999 – August 2001 (n = 30)
C-section Type
Elective
Non-Elective
#
%
Reason†
HIV Indication
Previous C-section
Malpresentation
Prolonged Labor
#
%
15
8
6
--
(68)
(36)
(27)
--
--1
4
--(13)
(50)
Fetal Distress
Placenta Abruptia/Previa
1
1
(5)
(5)
5
--
(63)
--
Other
Unknown
9
--
(41)
--
3
--
(38)
--
* C-section = Caesarian-section
† Participant may have more than one reason for C-section
Data Source: Minnesota HIV/AIDS Surveillance System
Enhanced Perinatal Surveillance Project
Minnesota EPS Project: Birth Characteristics –
Neonatal Antiretroviral Therapy (ART) by Time of Mother’s Diagnosis
January 1999 - August 2001 (n = 70)
Neonatal ART
Time of Diagnosis
Yes
No
Before Pregnancy
37
0
During Pregnancy
30
0
At Time of Delivery
2
1
Overall 98.6% (69/70) of children received antiretroviral therapy during the neonatal period.
Data Source: Minnesota HIV/AIDS Surveillance System
Enhanced Perinatal Surveillance Project
Minnesota EPS Project: Other Perinatal Characteristics
January 1999 - August 2001 (n = 70)
Characteristic
No Prenatal Care
Prenatal Care began 3rd trimester
Drug Use* During Pregnancy
Positive Toxicology Screen
Mother
Infant
STD Dx During Pregnancy
Ruptured Membranes for > 4 hrs
Number
Percent
4
7
14
(4)
(10)
(20)
9
2
18
21
(13)
(2)
(26)
(30)
* Drug use includes any illegal substance STD = Sexually transmitted disease (non-HIV) Dx = Diagnosed
Data Source: Minnesota HIV/AIDS Surveillance System
Enhanced Perinatal Surveillance Project
Conclusions (I)

The rate of perinatal HIV transmission in Minnesota is very low.

During 2000-2002 no perinatal HIV transmission occurred in
Minnesota among mothers receiving antiretroviral therapy (ART)
during pregnancy or labor/delivery.

During this time 2 cases of perinatal HIV infection occurred among 90 births to
HIV-infected women (2% transmission), in both cases neither mother nor infant
received ART.

The annual number of births to HIV-infected women living in
Minnesota has been steadily increasing since 1996.

ART was provided to over 95% of mothers and infants during 20002002.
Conclusions (II)

Surveillance data show that overall the Public Health Service
Guidelines of 1994/1995 have been successfully implemented
among HIV-infected women in Minnesota.

However, women of color and those born outside the U.S. were more
likely to be diagnosed with HIV after the birth of an infected child.


Efforts are needed to make universal HIV testing during pregnancy
more accepted by women of all races and cultures; likewise such testing
needs to be offered in a culturally and linguistically appropriate manner.
As a result of the Enhanced Perinatal Surveillance Project the
uninfected status of 62 perinatally exposed children and the infected
status of 1 child were updated.

The Minnesota Department of Health will work with health care
providers and clinics to improve reporting. Accurate monitoring of the
HIV/AIDS epidemic is dependent on accurate, complete, and timely
reporting of disease status.