positive mothers giving birth to HIV

Ending With a Success Story

There has been one major treatment success story in women in the U.S. that needs to be commended, which is in the domain of prevention of mother-to-child transmission (PMTCT). The risk of HIV-positive mothers giving birth to HIV-positive babies has decreased from approximately 25% in 1993 to less than 1% today due to appropriate treatment. This decline is secondary to increasing HIV testing rates during pre-natal visits, increasing use of HAART in HIV-positive women during their pregnancies to prevent transmission to the fetus, and an increase in elective Cesarean-section births by HIV-positive women with viral loads that are greater than 1,000 copies/ml.

Worldwide, the number and percentage of women accessing PMTCT medications has also increased from approximately 10% in 2004 to almost 35% in 2007, although rates of such access are still woefully low.

The current guidelines in the U.S. for PMTCT are to start HAART in the second trimester if the mother is not already on therapy and to give intravenous zidovudine (AZT) to the mother during delivery. At the time of delivery, the options for the delivery mode are determined by the mother's HIV viral load.

If the viral load is less than 1,000 copies/ml, vaginal delivery is as safe as C-section in terms of transmission rate to the baby. The baby receives six weeks of oral AZT after delivery. If no treatment is started prior to labor, the mother and infant should receive treatment at birth and the infant should receive post-exposure prophylaxis [HIV medications used to prevent infection].

In summary, HIV infection rates are increasing disproportionately among women, especially in minority groups. Prevention of HIV in women needs to come from increased awareness of HIV through routine screening and through providing women with effective, safe, female-centered prevention methods. Of the little that is known regarding HIV treatment and women, we know that women will do as well, if not better, on ARVs compared to men. This may be in part due to higher levels of drugs found in women, which may also explain the higher levels of side effects of these medications in HIV-positive women.

Despite the improvement in HIV treatment outcomes in women, gender disparities, abuse, and stigma still remain significant barriers to HIV prevention and treatment.

And finally, it is important to focus on PMTCT as a success story in the U.S. because this story shows that, when significant research and program implementation efforts are instituted, amazing progress in HIV prevention and treatment is possible. This should serve as an example for increasing research efforts and special programs aimed at improving HIV prevention and treatment for women.

Monica Gandhi, M.D., MPH, is an Assistant Professor of Medicine in the Division of HIV/AIDS at the University of California, San Francisco (UCSF). She specializes in the clinical care of HIV-infected women and directs the HIV inpatient consult service at San Francisco General Hospital. Her research career is focused on examining treatment issues for HIV-infected women in the Women's Interagency HIV Study (WIHS), a large prospective multicenter cohort study of HIV-infected women.