• Mary Jo Trepka, Soumyadeep Mukherjee, Consuelo Beck-Sagué, Lorene M Maddox, Kristopher P Fennie, Diana M Sheehan, Maithri Prabhakar, Dan Thompson, and Spencer Lieb.
• From the Departments of Epidemiology and Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, the HIV/AIDS Section, and the Maternal and Child Health Section, Florida Department of Health, Tallahassee, and the Florida Consortium for HIV/AIDS Research, The AIDS Institute, Tampa.
• South. Med. J. 2017 Feb 1; 110 (2): 116128116-128.

ObjectivesDespite declining numbers of perinatally exposed infants, an increase in perinatal human immunodeficiency virus (HIV) infections from 2011 to 2013 prompted this study to identify missed perinatal HIV prevention opportunities.MethodsDeidentified records of children born from 2007 through 2014, exposed to HIV perinatally, and reported to the Florida Department of Health were obtained. Crude relative risks (RRs) and 95% confidence intervals (CIs) for factors associated with perinatal transmission, nondiagnosis of maternal HIV infection, and nonreceipt of antiretroviral medication were calculated.ResultsOf the 4337 known singleton births exposed to maternal HIV infection, 70 (1.6%) were perinatally infected. Among perinatal transmission cases, more than one-third of mothers used illegal drugs or acquired a sexually transmitted infection during pregnancy. Perinatal transmission was most strongly associated with maternal HIV diagnosis during labor and delivery (RR 5.66, 95% CI 2.31-13.91) or after birth (RR 26.50, 95% CI 15.44-45.49) compared with antenatally or prenatally. Among the 29 women whose infection was not known before pregnancy and whose child was perinatally infected, 18 were not diagnosed during pregnancy; 12 had evidence of an acute HIV infection, and 6 had no prenatal care.ConclusionsLate diagnosis of maternal HIV infection appeared to be primarily the result of acute maternal infections and inadequate prenatal care. In Florida, effective programs to improve utilization of prenatal care and detection and primary prevention of prenatal acute infection are needed.

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