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Worldwide, WHO estimates 1.1 million children living with HIV

590,000 newly infected children in 2002

In US, HIV linked to rapidly growing HIV problem in women

In US, estimated 12,240 children living with HIT in early 1994

90% of cases due to perinatal transmission in 1995

Greatest number of children in Southeast, NY/NJ/DC, Puerto Rico

Epidemiology in children in the future will reflect overlap of two trends- Epidemiology of HIV in women 
and the epidemiology of good prenatal health care which can prevent much of HIV infection

Impact of ACTG 076 already evident. Pediatric AIDS rates falling nationwide, but implementation is inconsistent. In the US, AIDS in children is theoretically eradicable.

Adolescents and HIV - rapidly increasing but a talk for another day...

Perinatal transmission

Overall transmission rate 14%-39%. Closer to 25-27% in developed countries. Recent understanding of timing of transmission has improved
                  

In utero (30-50% of transmission)

Working definition: Evidence of virus by culture/l:'CR at birth (by day 7)

Peripartum (50-75% of transmission)

Working definition: negative virus culture/PCR at birth, + after day 7

Breast Feeding

Risk clearly confirmed, magnitude modest (7-22%) but inexact

Prevention

Drug therapy - AZT

ACTG 076: AZT po beginning after wk 12, IV during delivery and po for baby 6 weeks after reduced risk by