Miami Herald - July 10, 2002
Fred Tasker, ftasker@herald.com

And the U.S. success has not been duplicated in poorer countries, especially in Africa, where U.N. studies say 800,000 children are born yearly with HIV infections, a majority through their infected mothers.

"Up to 30 percent of African teenagers coming to clinics to give birth are found to be HIV-positive," said Dr. Bernhard Schwartlander, director of the HIV/AIDS department of the World Health Organization.

A U.S. Census Bureau study for the U.S. Agency for International Development said that, in the African countries of Botswana, Zimbabwe, South Africa and Namibia, more infants will die of AIDS in the next decade than from all other causes.

The success of American efforts was announced at the 14th International AIDS Conference.

A CDC study estimated that 300 U.S. infants were born HIV-positive in 2000, down from 1,760 in 1991, the peak year of infections.

"This dramatic reduction in the number of HIV infections in newborns clearly demonstrates remarkable progress," said Dr. Harold Jaffe, acting director of the CDC's HIV, sexually transmitted diseases and tuberculosis prevention programs.

The CDC researchers warned, however, that HIV infection rates among women were on the rise, which means that eliminating the transmission of the virus from mothers to children will prove increasingly difficult without a reduction in the number of women becoming infected.

From 1991 to 2000, the number of HIV-positive women of childbearing age -- 13 to 44 -- in the United States soared from 80,000 to 135,000, the CDC said.

Doctors and scientists gave presentations on studies of mother-to-child HIV transmission in San Francisco, Los Angeles, New York, Vancouver, British Columbia, and Israel.

In a typical program, mothers with HIV were given multidrug "cocktails" including Zidovudine, Nevirapine and other antiretrovirals before, during and after giving birth. The infants then were treated for six weeks with Zidovudine alone, to avoid toxicity.

Mothers were counseled not to breast-feed, which might increase the danger of transmission.

In general, only about 2 percent of infants born to HIV-positive women contracted the virus if the mother was diagnosed before birth and received the drugs. If the diagnosis was made only after birth, however, and the mother received no therapy, the transmission rate rocketed to 25 percent.

But even a 2 percent risk means 120 to 130 infants will be born HIV-positive, says Patricia Fleming, who presented the study, meaning that even more effective treatments must be created.

"Unless we can reduce the number of new infections in women, it will be difficult to achieve further reductions in newborn infections," she said.

"The simple fact is that the best way to prevent new infections in babies is to prevent infections in mothers."

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