Medical care among HIV positive pregnant women in eastern North Carolina

Background: Eastern North Carolina is in a rural setting with some regions having limited access to health care. African American women of reproductive age in the Southeast USA are disproportionately affected by HIV epidemic. There is little data describing HIV infection and pregnancies among this high risk population.

Methods: A retrospective chart review of all deliveries to HIV positive women from Jan 2001 to June 2009 at Pitt County Memorial Hospital (PCMH) was performed. PCMH is a tertiary regional hospital serving a rural population of which 30% are African American. Results: 105 HIV infected pregnant women were identified. Median age was 26(range 15-40). 77% were African American. Among 48 women (46%) who were newly diagnosed with HIV during prenatal visit, 21 were diagnosed in 1st trimester, 17 were diagnosed in 2nd trimester and 10 were diagnosed in 3rd trimester. 45% had undetectable viral load at delivery. Time lag between diagnosis of HIV or pregnancy and initiation of HAART therapy was <1 month for 31% (n=33), and >3 months for 28.5% (n=30) of the patients. 4% (n=4) were not on therapy at time of delivery. There were 5 vertical transmissions.

Discussion: 1)46 % of the women were newly diagnosed with HIV during prenatal visit and 20% were diagnosed in their 3rd trimester. This highlights that HIV screening is not being implemented efficiently in this high risk population. 2)Only 45% of the women went into labor with undetectable viral load. The time lag between diagnosis of HIV and initiation of antiretroviral therapy was >1 month in 69% of the mothers. Late HIV diagnosis and long time lag between diagnosis and initiation of therapy might have contributed to the failure in suppressing the virus. Good means of communication between prenatal clinics and HIV clinics is urgently required to address this critical time lost.