By Marie Rosenthal, MS
More than half of Medicaid-insured infants diagnosed with HIV did not receive postnatal antiretroviral prophylaxis within their first 12 months of life, according to data that was presented at IDWeek 2024, in Los Angeles.
These were missed opportunities to prevent HIV transmission, because all infants born to people living with HIV should receive postnatal antiretroviral prophylaxis, according to Mingyue Lu, PhD student in health policy and administration at the University of Illinois Chicago School of Public Health and presenting author, who spoke during a press briefing sponsored by the Infectious Diseases Society of America.
“There were no large scale studies reporting the real-world practice of postnatal antiretroviral prophylaxis in the United States,” Ms. Lu explained. “To provide information that can impact policies, we decided to conduct a study using a large scale Medicaid dataset. In this study, we identified antiretroviral use among infants and classified them into single-, double- and triple-drug prophylaxis. In parallel, we evaluated the number of new infections and characterized them in terms of the demographics and prophylaxis regimen.”
The data are based on a population-based retrospective study using the MarketScan Multi-State Medicaid Database from 2009 to 2021, which recorded antiretroviral prescriptions among infants. More than 3.147 million infants, who did not receive prophylaxis, were identified during the study period. Thirty-six of them had HIV.
They found that 2,304 received postnatal antiretroviral prophylaxis, with 2,123 receiving zidovudine (ZVD) single prophylaxis; 86 receiving ZVD and nevirapine (NVP); 73 receiving NVP triple prophylaxis; 20 receiving raltegravir trip therapy; and two receiving lopinavir-ritonavir triple prophylaxis. Of these, six in the ZVD group, eight in the ZVD-NVP double group, one in the NVP triple group, one in the raltegravier triple group was diagnosed with HIV.
During the study period, 52 infants were infected with HIV, and among them, 27 (51.9%) did not receive postnatal prophylaxis.
“While testing and treatment regimens for perinatal and postnatal HIV prevention have evolved, continued evaluation of how they work in the real world is needed,” Ms. Lu said. “Data suggest that clinicians are following national guidelines reasonably well. However, these highly effective interventions can be used only when maternal HIV infection is known. Therefore, efforts to minimize missed maternal HIV infection are crucial.”
The study is the first large-scale analysis of postnatal or perinatal prophylactic use, which could help to strengthen policy that addresses HIV diagnosis and treatment gaps, Ms. Lu said.
“Although the perinatal HIV infection rate was low, more than a half of HIV infections by a year of life occurred in infants who had not received postnatal HIV prophylaxis, suggesting missed maternal infections most frequently in the Black population. Increased access to prenatal care to promote HIV screening and treatment programs in all populations, including minoritized populations, must be improved,” Ms. Lu said, adding that public health research should explore more effective outreach, education and support programs during pregnancy to help vulnerable communities.
