Although bad news in the HIV arena seems par for the course these days, one bright spot was announced in late January. According to U.S. health officials, mother-to-child HIV transmissions have been virtually eliminated through the effective use of antiretroviral treatment. The availability of anti-HIV medications for HIV-positive pregnant women and their infants has reduced the number of babies born infected with the virus to about 200 per year, down from more than 2,000 annually around 1990.
In the 1980s and early 1990s the odds of an HIV-positive pregnant woman passing the virus to her child was 20% to 25%, according to federal health officials. In New York City alone there were 321 infants born with HIV infection in 1990, The New York Times reports. But a study launched in 1994 showed that providing short courses of AZT to HIV-positive women shortly before and during childbirth and to their infants immediately after birth could cut vertical transmissions by two thirds. One year after AZT treatment became routine, the U.S. mother-to-child transmission rate fell to just 8%, according to the National Institutes of Health. Since then, better antiretroviral drugs and expanded efforts to test pregnant women for the virus have reduced the rate to a record low. In New York, for example, just five babies were born with HIV infection in 2003.
'This is a dramatic and wonderful success story,' Vicki Peters, head of pediatric surveillance for the New York City health department, told the Times.
Because of the ability of drug therapy to dramatically reduce vertical HIV infections, many states have passed laws making HIV antibody testing routine for all pregnant women'unless they specifically opt out of testing'in the hope of identifying and treating every HIV-positive mother. Some states even mandate testing of infants born to HIV-positive women so that a last-chance course of anti-HIV drugs can be given to the newborns to help prevent infection from permanently taking hold.
The success to date in reducing vertical HIV infections has led some U.S. health experts to talk of completely wiping out such transmissions through intensified testing and treatment programs. Other Western nations are reporting similar success stories and eradication goals.
But the picture is very different, AIDS experts say, in the developing world, where vertical transmission is still a major route for the spread of the disease. The Joint United Nations Programme on HIV/AIDS estimates that more than 500,000 children worldwide are born infected with HIV each year.
'If you think about the United States and New York, and then you think about Africa, it is like a tale of two cities, a tale of two epidemics,' Lynne Mofenson of the NIH told the Times.