Important note: Information in this article was accurate in 1999. The state of the art may have changed since the publication date.
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The Wall Street Journal - January 29, 1999
Ron Winslow, Staff Reporter of The Wall Street Journal
The findings, from a study involving more than 8,500 mothers and their babies, provide a significant new strategy for pregnant women with human immune deficiency virus, or HIV, to prevent their children from developing AIDS.
Indeed, the results were considered so powerful and significant to public health that editors at the New England Journal of Medicine took the unusual step of releasing the report two months before its scheduled publication on April 1.
"The results show there is a very strong relationship between how you deliver the baby and transmission," said Jennifer S. Read, a pediatrician at the National Institute of Child Health and Human Development, part of the National Institutes of Health. "This information should be included in counseling of HIV-infected women during pregnancy."
Under current treatment standards, pregnant HIV-infected women are given the antiviral medicine AZT during pregnancy and delivery. It is also given to the infant after birth. A previous study demonstrated that this regimen can reduce the rate of transmission to about 8%, compared with 25% for women not taking the drug.
The new study, coordinated by Dr. Read, was based on an analysis that combined results of 15 studies from North America and Europe. In the new study, the rate of transmission for women who had neither treatment was 19%.
The study found that when women had both an elective C-section before labor and drug therapy, the rate of HIV transmission was reduced to 2%, an 87% reduction compared with women who had neither the drug therapy nor an elective C-section.
For those with elective C-section but no drug therapy, the transmission rate was 10.4%. AZT therapy without a C-section led to a 7.3% transmission rate.
Use of elective C-sections for HIV-infected women is much higher in Europe than in North America, Dr. Read said, because previous studies there have shown the benefit of the strategy, while earlier studies in the U.S. and Canada haven't.
Dr. Read said the findings of the new report underscore how critical the period immediately prior to delivery is in preventing HIV transmission, but noted that elective C-sections carry their own risk of complications.
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