Follow-up and Outcomes of Infants Perinatally-exposed to HIV in a Low-prevalence Setting: The Multicenter Children's HIV Exposure Study 2

Abstract

OBJECTIVE: To investigate the follow-up and outcomes of HIV-exposed infants in a setting of low HIV prevalence. STUDY DESIGN: This was a multicenter, retrospective study of live-born infants of women known to be living with HIV, at 9 tertiary pediatric centers in Australia and New Zealand from 2009-2025. Antenatal, perinatal, and postnatal data, and outcomes at clinic visits to 18 months of age were collected, including co-morbidities, development, and HIV results. RESULTS: Six hundred sixty-eight infants were born from 657 pregnancies to 530 women living with HIV. Two (0.3%) infants were HIV-infected. Regarding preventative interventions, 612/616 (99.4%) pregnant women received combination antiretroviral (ARV) therapy, 660/661 (99.8%) infants received ARV prophylaxis, and 543/568 (96%) exclusively formula fed. A total of 94/588 (16%) born <37 weeks, 106/600 (18%) had birth weight <2500 g, and 26/642 (4%) had congenital abnormalities. HIV polymerase chain reaction (PCR) testing was done for 621/668 (93%) within 2 weeks, 598/664 (90%) at 6 weeks, 582/657 (89%) after 3 months, with a combined total of 643/657 (98%) infants having at least one post 6-week HIV PCR result. At 18-month follow-up, 24/426 (6%) had developmental delay and 47/426 (11%) had at least 1 comorbidity. A total of 577/668 (86%) infants were confirmed as HIV-negative by either negative antibody or 2 negative PCR tests over the age of 6 weeks. CONCLUSIONS: The perinatal transmission rate of 0.3% was extremely low. While the majority of infants were followed up well, the proportion of infants with developmental delay and co-morbidities highlights the need for improved engagement, even in a low-prevalence setting.