Trends in age at the first medical evaluation of human immunodeficiency virus infection among infants born to infected mothers

Objective: To evaluate the trends in age at the first medical evaluation of human immunodeficiency virus (HIV) infection among infants enrolled in the Pediatric Spectrum of Disease study born to mothers infected with HIV. Design: Retrospective study based on medical chart review. Setting: Nine pediatric centers in New York City. Participants: Infants (N=925) born between January 1988 and December 1991 to mothers infected with HIV; the infants were examined for HIV infection by age 2 years and were receiving medical care. Results: In each successive birth cohort, an increasing proportion of infants was examined by 3 months of age (from 35% in 1988 to 76% in 1991, chi(2)=38.1, P<.001). The median age at the first evaluation persistently declined among the cohort evaluated by 24 months. The median age decreased from 6 months in 1988 to less than 1 month in 1991. The proportion of infants who were examined because of HIV-related symptoms decreased in each successive birth cohort (1988, 65%; 1989, 59%; 1990; 42%; and 1991, 25%). Conclusions: An increasing proportion of newborns exposed to HIV are being examined within the first 3 months of life in 9 leading pediatric HIV centers in New York City. Prenatal HIV counseling and testing of mothers are optimal procedures because they benefit mothers, they allow the use of zidovudine to reduce the chance of HIV infection in the infants, and they allow mothers with HIV to be counseled about the potential risks of breastfeeding. The family and the pediatrician must have knowledge of the infants' HIV status as early in life as possible to allow the necessary postnatal interventions, including Pneumocystis carinii pneumonia prophylaxis, which reduces morbidity and may prolong survival.