Important note: Information in this article was accurate in 1999. The state of the art may have changed since the publication date.
The Associated Press - August 11, 1999
An expert not involved in the study said it suggests the possibility of virtually eliminating mother-to-child HIV transmission in the U.S., an idea that was almost unimaginable a few years ago. However the problem is still significant in developing countries.
"This is a remarkable success story for ... everybody involved in caring for these women and the women themselves," said the study's lead author, Dr. Mary Lou Lindegren, an epidemiologist with the federal Centers for Disease Control and Prevention in Atlanta.
"We still have more to go, but we've been dramatically successful," she said. The number of babies who developed AIDS after being infected with HIV before or during birth peaked at 907 in 1992, then declined 67% over the next five years, to 297 in 1997, the researchers reported in Wednesday's Journal of the American Medical Association.
The researchers believe the number of babies born HIV-infected is higher, since it can take years for HIV to develop into AIDS.
Only 32 states collect information on HIV infection in newborns, but the CDC estimates that 1,650 babies caught the virus from their mothers in 1991, at the epidemic's peak. By 1996, that number had fallen to 480, a 71% drop, Ms. Lindegren said.
Scientists discovered in 1994 that treatment with AZT, now called zidovudine, reduced a newborn's risk of catching HIV from 26% to 8%. In that study, the drug was given to HIV-infected women during pregnancy and labor and to the newborn for the first six weeks of life, said Dr. Lynne M. Mofenson of the National Institute of Child Health and Human Development.
Since then, doctors have found that prenatal AZT can actually reduce the risk to as low as 3 percent, Dr. Mofenson noted in an editorial accompanying the study. Delivering at-risk babies by Caesarean section lowers the risk further, she said.
Also, if women are getting treatment with powerful AIDS-fighting drug regimens that can reduce virus levels in the blood to undetectable amounts, the risk may fall to less than 1 percent, she said, citing other research.
That means virtual elimination of mother-to-child transmission in the U.S. looks possible, Dr. Mofenson said.
Authors of the new study said zidovudine is the main reason for the drop in AIDS cases in newborns, but not the only one. One other factor is that the number of babies born to infected women fell 17% during the study period.
The biggest challenge now is reducing mother-to-child transmission worldwide. An estimated 1,800 HIV-infected babies are born daily in developing countries and the cost of zidovudine has kept widespread treatment out of reach there.
In wealthy countries, HIV-infected pregnant women typically receive five months of zidovudine therapy, which can cost more than $1,000. Zidovudine is offered in developing countries at up to 75% less than in the West, according to British manufacturer Glaxo Wellcome Inc.
Hopes are soaring since African scientists' recent finding that a new drug, nevirapine, appears to work better and at far lower cost -- an anticipated $4 a dose.
"The recent demonstration that a two-dose nevirapine regimen as well as short zidovudine regimens can reduce perinatal [at-birth] transmission brings new hope to developing countries, but implementation will be challenging," Dr. Mofenson wrote.
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