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1996-02-27
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Document 0634
DOCN M9630634
TI Failure to identify human immunodeficiency virus-seropositive newborns:
epidemiology and enrollment patterns in a predominantly white, nonurban
setting.
DT 9603
AU Coplan J; Dye TD; Contello KA; Cunningham CK; Kirkwood K; Weiner LB;
Department of Pediatrics, State University of New York-Health; Science
Center at Syracuse 13210, USA.
SO Pediatrics. 1995 Dec;96(6):1083-9. Unique Identifier : AIDSLINE
MED/96095158
AB OBJECTIVE. To describe the epidemiology of newborn seroprevalence for
human immunodeficiency virus (HIV) in a predominantly white, nonurban
population, and to determine the factors associated with enrollment at a
regional pediatric acquired immunodeficiency syndrome (AIDS) center
serving that population. DESIGN. Retrospective case series of children
enrolled at a regional pediatric AIDS center during a 6-year period and
comparison with universal blind newborn screening data collected by the
state of New York during the same time interval. SETTING. The Pediatric
AIDS Center at State University of New York-Health Science Center at
Syracuse, which serves as the only source of HIV-related pediatric care
for children in a 16-country region of upstate New York totaling 1.8
million population. RESULTS. One hundred thirty-nine HIV-seropositive
infants were born in the region during the 6-year study period; complete
blind screening data were available for 138. Sixty-five (47%) of these
infants were white. Thirty-nine (28%) of 138 had been enrolled at the
Pediatric AIDS Center within the first 90 days of life. An additional 22
(16%) were enrolled at older than 90 days of life. The remaining 77
(56%) have never been seen at the center and are presumed to be
unidentified. County enrollment rates varied from 0% to 100% and
correlated with percent nonwhite births (r = .58; 95% confidence
interval, 0.04-0.86). Children in outlying counties were at greater risk
for nonenrollment than children from Onondaga County (site of the
Pediatric AIDS Center) (adjusted relative risk, 1.38; 95% confidence
interval, 1.05-1.85). White infants residing outside of Onondaga County
were at the greatest risk of nonenrollment; of 50 seropositive white
infants residing outside of Onondaga County, only 7 (14%) were enrolled
at the center within the first 90 days of life. CONCLUSIONS. Local
demographic factors can skew the racial distribution of HIV-seropositive
infants dramatically compared with the national experience. White race
and residence in counties away from the medical center each constituted
risk factors for nonenrollment at the Pediatric AIDS Center. The
epidemiology of HIV in this predominantly white, rural population,
coupled with physician practices, probably contributed to low
identification and enrollment rates. As the AIDS epidemic spreads into
similar populations elsewhere, HIV infection in pregnant women or
newborn infants is likely to become progressively harder to detect,
unless universal screening is adopted.
DE Blacks/STATISTICS & NUMER DATA Chi-Square Distribution Comparative
Study Data Collection/METHODS Female Hispanic Americans/STATISTICS &
NUMER DATA Human HIV Seropositivity/*EPIDEMIOLOGY *HIV Seroprevalence
HIV-1/*IMMUNOLOGY Infant, Newborn Male New York/EPIDEMIOLOGY
Retrospective Studies Risk Factors Rural Population/*STATISTICS &
NUMER DATA Whites/*STATISTICS & NUMER DATA JOURNAL ARTICLE
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).