Newsday - December 13, 1991
Laurie Garrett - Staff Writer
In studies of twins born to HIV-infected mothers, researchers at the National Cancer Institute found that most of those who became infected did so during birth, rather than in the uterus.
"This finding suggests that we may be able to develop methods of preventing HIV transmission from mother to child," said senior institute researcher Dr. James Goedert, adding that simple changes in obstetric practices or the use of agents to cleanse the birth canal of HIV might dramatically reduce the numbers of babies born with the virus.
During the last 10 years, some 3,000 babies in the United States have been born infected with HIV, and the World Health Organization estimates a quarter million infants are infected worldwide.
The institute's findings, which appear in today's issue of the British medical journal, The Lancet, are based on twins born throughout the world; many of the twins were studied in hospitals in New York City and Long Island.
Last year the institute created an international registry of HIV twins, aimed at finding out how they became infected. To date, 101 sets of twins, in which one or both carry HIV, have been registered. Today's study focuses on the 32 sets of twins for which the clearest data are available.
They discovered that half of the first-born twins who were delivered by natural means became infected; 38 percent of the first-born delivered by caesarean section were infected. But only 19 percent of the second-born babies, whether delivered vaginally or by caesarean, were HIV infected.
Studies of mother-to-baby transmission of other viruses, such as hepatitis B and herpes, show a similar pattern, Goedert said in an interview, because it is the first-born twin that does all the work of opening the birth canal, making it most likely to be pushing against maternal tissue and to suffer cuts or swallow maternal blood and fluid.
Similarly, the twin closest to the mother's cervix is most likely to have a broken fetal membrane by the time a caesarean is performed, thus putting it in contact with maternal blood.
If transmission occurred primarily in the uterus, Goedert said, both twins ought to be at equal risk.
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