The Canadian Perinatal HIV Surveillance Project (CPHSP): changes in demographics and HIV transmission rates

Background: To describe changes in perinatal HIV exposure demographics and transmission in the cohort of mother-infant pairs (MIP) enrolled in the CPHSP.
Methods: CPHSP has collected data since 1984 on all identified perinatally HIV exposed children. Across Canada, 24 pediatric centres, HIV clinics and Health Authorities provide data which is entered at a single site and reviewed to identify duplicate entries/miscoding. Collected data includes demographics, antiretroviral exposure, HIV testing outcome of the infant and annual follow-up. The “perinatal cohort” includes only those MIP identified before the infants were 3 months of age. Demographic changes between Pa (1984-1996) and Pb (1997-2004) and HIV transmission rates and antiretroviral therapy exposure between P1 (1990-1996) and P2 (1997-2004) are described.
Results: : Since 1984, 2005 children were identified of which 465 were HIV-infected. Maternal risk categories remained constant over time. The proportion of aboriginal infants has increased (Pa 9.9% of 759 vs Pb 18.3% of 1139). Of 1725 HIV exposed children identified between 1990 and 2004, 1473 met criteria for the “perinatal cohort”. In P1 the transmission rate was 12.1% (Total N=365) overall and 5.7% (Total N =154) with any ART exposure. In P2 the transmission rate was 3.2 % (Total N=1108 ) overall and 1.6% (Total N=931)with any ART exposure. In P2 70% of ART cohort received 3 or more drugs with infection rate of 0.97% . In 2004 96% of identified MIP (N=161) received ART.
Conclusions: The proportion of MIP that received ART has doubled and infection rate has decreased by 75%. The effectiveness of perinatal ART and management is reflected in greater use of perinatal combination ART and decreased infection rates. The CPHSP helps to identify demographic changes within the Canadian HIV epidemic. This helps to develop appropriate programmatic responses. Ongoing efforts must ensure infected pregnant women are identified and receive appropriate combination ART.

L. Samson1, J. Forbes2, A. Alimenti2, J. Singer3, D. Money2, N. Lapointe4, Canadian Pediatric AIDS Research Group
1Children's Hospital of Eastern Ontario, Ottawa, Canada, 2Oak Tree Clinic, Vancouver, Canada, 3CTN, Vancouver, Canada, 4Ste Justine Hospital, Montreal, Canada