AIDSWEEKLY Plus, Monday, 20 October 1997
Daniel J. DeNoon, Senior Editor
Increased use of zidovudine (AZT) plus routine HIV counseling and voluntary HIV testing for pregnant women has decreased mother-to-child HIV transmission dramatically.
The finding comes from a study by the U.S. Centers for Disease Control and Prevention (CDC) that assessed implementation of U.S. Public Health Service (PHS) recommendations. In August 1994, the PHS recommended AZT use for all pregnant women with HIV infection, and in 1995 added routine counseling and voluntary testing to its standard of obstetric care.
"Increasing proportions of mothers and newborns are receiving AZT, resulting in fewer infants becoming HIV infected," said Mary Lou Lindegren of the CDC's Division of HIV/AIDS Prevention. "In addition, the study shows that many HIV infected women are diagnosed with HIV infection before their child's birth."
Lindegren announced the study findings in an address to the American Society for Microbiology's 37th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), held September 28 to October 1, 1997, in Toronto, Ontario, Canada.
A landmark clinical trial (AIDS Clinical Trials Groups (ACTG) protocol 076) in 1994 showed that administration of AZT to pregnant women with HIV infection and to their babies reduced by two-thirds the odds that a mother would pass the infection on to her child.
Prior to 1994, about one-fourth of such children became infected.
The CDC study analyzed data collected through 1996 from the 29 states that monitor children perinatally exposed to HIV. It showed that of 1,202 children born to HIV(+) mothers from September 1994 to December 1995, 12 percent (82/660) of those who received any AZT (prenatally, intrapartum, or neonatally) became infected versus 30 percent (65/216) of those who never received AZT.
The study also revealed other significant data: * HIV infected mothers' knowledge of HIV status prior to childbirth increased from 72 percent in the first half of 1993 to 87 percent in the first half of 1996.
* Of the 3,367 children monitored, 286 had AIDS. Among these AIDS cases, 9 percent received any AZT while 6 percent received prenatal AZT.
* Increasing proportions of women are receiving AZT during pregnancy, but many women with HIV infection still do not. In the first half of 1996, 58 percent of the women in the study received the drug during the prenatal period. In first-half 1993, only 1 percent received prenatal AZT and this rate had increased to only 34 percent by first-half 1995.
"This study helps demonstrate that the recommendations for voluntary counseling and testing of pregnant women and the use of AZT therapy are being implemented by health care providers and that these services are being accepted by increasing numbers of HIV positive women," Lindegren said.
She said that her group currently is trying to determine whether the children that do acquire HIV infection from their mothers represent "prevention failures or treatment failures."
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