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| PEDIATRIC AIDS
- Mother to Child transmission - A preventable illness |
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Dobrzanski Wanda M.D. – Pediatrician Specialized in Pediatric Infectious Diseases -
"Argentine Society of Pediatrics" Member - "Argentine Society of Infectious
Diseases" Member - Fogarty Research Fellow in the Division of Pediatric Immunology and
Infectious Diseases at the University of Miami, School of Medicine - 1998. Pediatric AIDS
Reference Center Hospital de Niños Ricardo Gutiérrez, from 1997 to January 2000 - Clinical
Research Associate, Ingenix International.
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There are over 33 million people in the world infected
with the HIV-1 virus and almost half of them are women in reproductive age (World Health
Organization - WHO - 1998 report). This data reveals the importance of this article written by
Dr. Wanda Dobrzanski; Infectious Diseases Pediatrician formed at the Hospital de Niños
Ricardo Gutiérrez, Buenos Aires, Argentina.
HIV-1 Mother to child transmission and its preventive point of view.
In Argentina, 90% of Pediatric AIDS cases come from maternal transmission. Mother to child
transmission of the HIV-1 virus can occur either in-utero, at the time of labour and delivery,
or postnatally through breast-feeding. By the experience reported by AIDS Clinical Trial Group
(ACTG), with the ACTG 076 protocol a new hope of an efficient strategy in prevention of
pediatric AIDS appears for medical community.
The World Health Organization (WHO) ending 1998 reported more than 33 million people in
the world infected with the HIV-1 virus and almost half of them are women in reproductive age.
In our country practically 90% of pediatric cases have been acquired through their mother. As
from 1995 with data obtained by de ACTG 076 protocol (AIDS Clinical Trial Group) the
percentage of mother-to-child transmission, as called today, significantly reduced in
approximately 70%. This study proved, that ZDV (Zidovudine) given to infected pregnant women,
as from week 14-16, during labour and for 6 weeks to the neonate after birth, the transmission
rate reduced from 25.5% (in the placebo group) to 8.5% (group treated with ZDV).
From then, a new hope arose within the world’s medical community.
For this reason at present the CDC recommends the prompt identification of the infection
by HIV-1 virus in every pregnant woman. Once diagnosed, ZDV is prescribed from week 14 up to
week 34, as well as intravenous ZDV during labour and to the newly born during the first weeks
of life.
Recently, the results obtained in Thailand with Nevirapine, a non-nucleoside reverse
transcriptase inhibitor, by administering one oral dose when beginning labour and one oral
dose to the newly born within 72 hours from birth, demonstrated a decrease rate of
approximately 50% . This scheme is an option for those developing countries, as sub-Saharan
Africa, where the greatest number of infected people with HIV-1 virus live.
There are other possible strategies, some already proven and others still under
investigation that could be utilized in order to reduce Mother- to-child transmission. Within
therapeutic treatments, supplementation of vitamin "A" and other micronutrients such
as Zinc and Selenium, could be implemented, following the finding that those mothers with low
serum levels of vitamin "A" are more likely to transmit HIV to their children and
with the benefit of low cost. Obstetric measures such as cervical and vaginal washing with
antiseptics and antiviral agents prior to delivery are at present under study and could prove
benefitious. The early treatment of urinary infections contributes to decrease the risk.
Elective Caesarean section has demonstrated to provide certain protection, even though
there is no conclusive data. On the other hand its feasibility is uncertain in many developing
countries; anyhow it has been proven that the rupture of membranes should not surpass four
hours due to the fact that passed this period transmission possibility increases.
In developing countries HIV transmission by breast-feeding is high and should be
particularly considered, bearing in mind that there is a larger risk of infant mortality by
malnutrition and intestinal infections rather than by contracting HIV-1 infection. Therefore
breast-feeding is not contraindicated taking into consideration this previous mentioned
situation. In Argentina as in other developed countries, breast-feeding is contraindicated as
a preventive measure.
According to what has been stated, a hope of preventing a devastating illness such as AIDS
arises, by joining efforts between medical community, government policies and society in
general.
In articles to come information here exposed shall be analyzed in further depth, with the
purpose of collaborating towards communication and prevention of AIDS in our country and rest
of the world.
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