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Children born to HIV-1-infected women in Sweden in 1982-2003: trends in epidemiology and vertical transmission.

Navér L, Lindgren S, Belfrage E, Gyllensten K, Lidman K, Gisslén M, Ehrnst A, Arneborn M, Bohlin AB

Department for Clinical Science, Intervention and Technology, Division of Pediatrics, Karolinska University Hospital Huddinge, Sweden. lars.naver@ki.se

To describe the HIV-1 epidemic among childbearing women and their children in Sweden, a population-based analysis of data on all known mother-child pairs in Sweden with perinatal exposure to HIV-1 1982-2003 was conducted. The mother-to-child transmission (MTCT) rate in children prospectively followed from birth decreased from 24.7% in 1985-1993 to 5.7% in 1994-1998 and 0.6% in 1999-2003. The use of antiretroviral treatment of the mother during pregnancy and/or prophylactic antiretroviral intervention increased from 2.3% to 91.6% during the same period, and the elective cesarean delivery rate increased from 8.0% to 80.3%. No MTCT of HIV-1 occurred in Sweden after 1999.Fifty-one vertically HIV-1-infected children aged 2.7 to 17.6 years were living in Sweden by 31 December 2003, 71% being treated with antiretroviral agents. No HIV-1-related child death has been reported in Sweden after 1996. The conclusion is that MTCT of HIV-1 can be almost eliminated when appropriate resources are available. A national pregnancy screening program for HIV-1 running since 1987 with a high acceptance rate and the implementation of measures to prevent MTCT since 1994 have resulted in a significant decrease in the number of infected children. Inasmuch as knowledge of the infection status of the mother is crucial for reduction in MTCT of HIV-1, continued antenatal screening is important even in a low-prevalence country such as Sweden.

Published 13 July 2006 in J Acquir Immune Defic Syndr, 42(4): 484-9.
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