San Francisco Chronicle - Friday, May 9, 2003
Demian Bulwa, Chronicle Staff Writer

Most hospitals, though, do not have experts in the field, which is both complex and rapidly changing. In response, Alameda County's Family Care Network and the UCSF Medical Center have started a 24-hour pager consultation service.

Officials have distributed the toll-free number to more than 100 delivery units and emergency rooms throughout Northern California. The focus is weekends, holidays and nights, when one of 10 clinicians with experience treating HIV-infected pregnant women will be available. Since a Feb. 1 launch, the line -- intended for hospital workers, not the public -- has received a handful of calls.

"Unless you're doing this all the time, (the technology) is impossible to keep up with. Patients have a right to know what is cutting-edge," said Stephanie Mann, a perinatologist at the UCSF Medical Center and one of the experts. Beth Hennessy, manager of perinatal services at Sequoia Hospital in Redwood City, said she recently instructed her staff on how to use the service.

Sequoia delivers 1,300 babies a year but rarely deals with drop-in, HIV- infected patients, Hennessy said.

"It would be helpful to have the information a phone call away," she said. "We might be talking about one case a year."

Mann said treating an HIV-infected woman -- or a woman that has many risk factors for the virus -- involves many variables, from the dosage of AZT and other drugs to making decisions about breast-feeding.

Treatment can change for premature babies, and HIV infection can affect delivery methods. Clinical studies and manufacturer warnings on drugs can also factor in.

"This is about giving people the best information so they can make the best choices," said Claire Borkert, co-medical director at the East Bay AIDS Center.

The center is a service of the Alta Bates Medical Center and is part of the Family Care Network, which includes 11 health centers and clinics.

Without therapy, babies born to HIV-infected mothers face a more than 25 percent chance of contracting the virus, Mann said. In the early 1990s, 1,000 to 2,000 infants per year were born HIV-positive in the United States, according to the Centers for Disease Control.

But in 1994, a landmark study showed the dramatic efficacy of AZT in preventing transmission. In 2000, 280 to 370 infants were born with HIV, and the risk of transmission now may be as low as 1 percent with proper care, the CDC said.

"We want to demystify this," Mann said. "It's become a specialty in itself."

E-mail Demian Bulwa at dbulwa@sfchronicle.com.
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