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The introduction of human immunodeficiency virus into the North Carolina pediatric population
C Grant1, R E McKinney, C Weedy
1Duke University Medical Center, Durham, NC 27710.
Insights
HIV transmission in children was primarily perinatal, with maternal intravenous drug use being a significant risk factor. Cocaine abuse in North Carolina correlated with higher HIV infection rates among mothers.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Human Immunodeficiency Virus (HIV) poses a significant health challenge, particularly concerning pediatric infections.
- Understanding transmission routes is crucial for effective prevention and intervention strategies.
Purpose of the Study:
- To analyze the modes of HIV seropositivity acquisition in children treated at Duke University Medical Center before September 1990.
- To identify risk factors associated with maternal HIV infection, especially within North Carolina.
Main Methods:
- Retrospective review of medical records for 134 HIV-seropositive children.
- Analysis of transmission routes: perinatal and blood product.
- Investigation of maternal risk factors, including intravenous (IV) drug use and geographic location of infection acquisition.
Main Results:
- Perinatal transmission accounted for 83% of cases (111 children), while blood product transmission accounted for 11% (15 children).
- Maternal intravenous (IV) drug use was the primary risk factor, identified in 84% of total cases.
- Women infected in North Carolina were significantly more likely to have acquired HIV from a sexual partner who used IV drugs (P < .001).
- Cocaine was the predominant IV drug used in North Carolina, with maternal HIV infection linked to areas of higher cocaine abuse treatment admissions.
Conclusions:
- Perinatal HIV transmission is the dominant route in pediatric cases.
- Maternal IV drug use, particularly cocaine, is a critical risk factor for HIV infection in women and subsequent transmission to children.
- Geographic correlation exists between areas of high cocaine abuse and maternal HIV infection rates in North Carolina.
Abstract:
The authors reviewed the means by which human immunodeficiency virus (HIV) seropositivity was acquired for the 134 seropositive children seen at Duke University Medical Center prior to September 1990. Perinatal transmission occurred in 111 (83%) and blood product transmission in 15 (11%). Of the 108 mothers (there were three sets of siblings) responsible for perinatal transmission, 44 (41%) had acquired their infection while residing in North Carolina. Intravenous (IV) drug use by the mother or her sexual partner was the significant risk factor for maternal infection in 91 (84%) of the total cases and in 38 (86%) of the 44 women infected in North Carolina. The proportion of women who acquired their HIV infection from a sexual partner who was an IV drug user was significantly greater for mothers who were resident in North Carolina when infected compared with mothers infected elsewhere (P less than .001). On the basis of admission to drug treatment programs during the 1990 fiscal year, cocaine is the predominant IV drug used in North Carolina. Admissions to cocaine abuse programs occurred throughout the state, and mothers who acquired HIV infection from IV drug use were more likely to live in counties with a higher frequency of cocaine abuse treatment.