Research letter Failure to prevent perinatal HIV infection

Perinatally transmitted HIV infections have continued to occur in Ontario despite the introduction of universal prenatal HIV counselling and voluntary testing guidelines in December 1998. We conducted a retrospective chart review of all infants diagnosed with perinatally acquired HIV infection over a 24-month period (August 1999 to July 2001), born to women who became pregnant subsequent to the introduction of these guidelines, with the purpose of determining possible reasons for the failure to eliminate perinatal transmission of HIV in Ontario. Data were extracted from the hospital charts of the infants. As part of the initial history, all HIV-infected mothers seen in our clinic were routinely questioned as to whether they received prenatal HIV counselling, whether they agreed to such testing, whether they thought such testing was performed and whether appropriate therapy was initiated and received. For ethical and legal reasons, no attempt was made to question the physicians who cared for the mothers during pregnancy regarding their antenatal care. An infant was considered to be HIV infected if HIV was detected by DNA polymerase chain reaction (PCR) or culture, or both, on 2 separate occasions. In Ontario, about two-thirds of children diagnosed as being HIV infected receive their care in the HIV/AIDS Family Centered Care Clinic at the Hospital for Sick Children, Toronto. 1 Six infants with perinatally (“vertically”) acquired HIV infection were identified (none of the infants had received blood products). For 4 infants, the diagnosis of HIV

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