Mother-to-child HIV transmission rate falling, but more can be done

July 22, 2010

GAINESVILLE, Fla. — Transmission of HIV to children before or at birth has dropped dramatically around the country in the last decade since the advent of powerful new therapies. That certainly is true for Florida, where each year, fewer than 10 babies are born with the disease despite the fact that more than 600 HIV-positive women each year, on average, give birth.

Still, more can be done to even further reduce the number of babies born with the disease, say pediatric HIV experts at the University of Florida who this week presented their work during the 18th International AIDS conference in Vienna, Austria.

“This is one of those diseases for which we learned how to prevent transmission. We need to make full use of this method and our energies need to be focused on the effort,” said lead researcher Dr. Mobeen Rathore, a professor and chief of pediatric infectious diseases and immunology at the University of Florida College of Medicine-Jacksonville, and director of the UF Center for HIV/AIDS Research, Education and Service.

Around the United States, the decreasing number of pediatric infections is a direct result of the advent of powerful anti-HIV therapies in the mid-1990s and the establishment of protocols by the Centers for Disease Control and Prevention to treat pregnant women who are infected, and their babies.

Increased HIV-testing outreach and education efforts have also paid off. And CDC guidelines for “opt-out” HIV-testing for pregnant women mean testing is a routine part of their care, and women would have to specifically decline it. Rapid testing during labor and delivery gives one last chance to administer therapies that can prevent transmission.

In Florida, the Targeted Outreach for Pregnant Women Act of 1998 was enacted to help improve prenatal care and reduce the number of babies with HIV or prenatal drug exposure.

After New York, Florida has the second highest number of babies born to HIV-positive women. The state began monitoring the number of HIV-exposed babies in 2006. Up to 2008, a total of 2,374 cases of pediatric HIV/AIDS have been reported in Florida. So far this year, just one case has been reported.

“The reduction of mother-to-child HIV transmission is one of the biggest success stories of the HIV epidemic,” said Thomas Liberti, chief of the bureau of HIV/AIDS in the Florida Department of Health. “The question is, ‘How low can we go?’”

The UF researchers teamed with colleagues in the Florida Department of Health Perinatal Prevention Division to review pediatric HIV data for the period from 2002-09, and found 102 cases.

Despite the many effective measures in place to help prevent HIV-transmission to babies, there are missed opportunities, the researchers found.

Mothers of half of the infected babies tested positive for HIV before becoming pregnant. But some refused or neglected to take the medications that could have kept their babies HIV-free. Some had no prenatal care, and so did not receive available treatments.

Some women were HIV-negative at the start of their pregnancy, but became infected afterward. Others were diagnosed with HIV only after the birth of their babies. Repeat testing during pregnancy and rapid testing during labor and delivery would have alerted health care providers.

The study shows that for some women, the issue might not be a lack of availability of medical services. Mental illness, intravenous drug use and incarceration and other risk factors associated with increased risk of HIV infection affected about one-third of the women who delivered infected babies. Mental health and substance abuse issues often prevent women from taking advantage of medical care or adhering to a treatment regimen prescribed by their physicians.

Finding creative ways to address issues such as the shortage of mental health-care providers will help women and their babies get needed care, the researchers said.

The health department has already begun discussions with the Centers for Disease Control and Prevention to discuss steps that can be taken to further reduce mother to child HIV transmission.

“Many of our patients have mental health and other life issues, so if we do not address them, the treatment protocol will not be effective,” Rathore said. “This is an intervention that has the opportunity to work better.”