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Pediatric AIDS Down But Not Out

New government study aims to reach infected moms, babies during delivery

FRIDAY, April 5, 2002 (HealthDayNews) -- The number of children born with HIV has fallen 80 percent over the past decade, largely because of powerful new medications, but hundreds of newborns are still infected with the AIDS virus each year because their mothers don't see a doctor until it's too late.

Now, the federal government has launched a nationwide hospital study it hopes could possibly eliminate infant AIDS forever. Part of a four-year, $10 million effort, the research will gauge the worth of starting drug treatment at birth in newborns whose mothers are diagnosed at delivery.

"We still have transmissions that occur, and inadequate prenatal care seems to be the major impediment," explains Dr. Marc Bulterys, a senior medical epidemiologist with the Centers for Disease Control and Prevention.

Unlike adults, who can't be cured of HIV infection, an estimated 30 percent to 50 percent of HIV-infected babies can eliminate the AIDS virus from their bodies. Researchers have shown they can recover if they receive medication for six weeks after birth and their mothers receive drug treatment during labor, Bulterys says.

In unborn children, infection seems to occur at or shortly before delivery, says Dr. Sally Slome, an HIV specialist with Kaiser Permanente Northern California. "No one knows specifically what event causes infection."

The problem of AIDS among children reached its peak in 1992, when the federal government estimated that 2,000 babies were infected. The numbers began to drop, however, as more mothers began taking AIDS drugs during pregnancy, lowering the level of HIV in their bodies.

Rates of HIV transmission to a newborn are as low as 1 percent to 2 percent if both the woman and the baby are treated with AIDS drugs before birth and delivery, Bulterys says.

"There's still a small group of so-called failures, where transmission still occurs despite excellent therapy," he says.

In most of those cases, the drugs can't eliminate the virus from the bloodstream. That is the goal of HIV treatment in adults, although the virus doesn't leave the body completely.

Over the past three years, the number of estimated HIV cases among newborns in the United States has stabilized between 280 and 370 a year, Bulterys says.

Only estimates are available because 18 states don't report the number of people with HIV infection. All states, however, must report people infected with AIDS.

In the new study, which began this year, hospitals will give rapid HIV tests to women in labor whose infection status is unknown. The tests, which are experimental, will give results in 15 minutes, Bulterys says.

If the tests on mothers are positive, the newborn babies will be tested immediately after birth. Treatment will begin right away for both mother and child if needed.

The hospitals serve disadvantaged populations, and as many as 20 percent of their pregnant mothers have not received prenatal care, Bulterys says.

The three-year study, which aims to test 18,000 women, has already begun at hospitals in New Orleans, Miami and Chicago. Later, it will start in Atlanta and New York City.

Slome says she understands the goals behind the study, but wonders if it is the right approach.

"My concern is that when you test everybody when they're in labor, you tend to avoid putting the focus on early education," she explains.

Prenatal care works wonders in HIV-infected women, she notes. The problem is getting them to care in the first place.

"We should put all of our energies toward that," she says.

What To Do

Comprehensive information about HIV and AIDS among young people is offered by the National Pediatric and Family HIV Research Center and the Division of AIDS at the National Institute of Allergy and Infectious Diseases.

Also, check The Body for simple explanations of HIV and AIDS.

SOURCES: Marc Bulterys, M.D., Ph.D., senior medical epidemiologist, Centers for Disease Control & Prevention, Atlanta; Sally Slome, M.D., senior physician, HIV specialist, Kaiser Permanente Northern California, Oakland
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