100% prevention of mother-to-child HIV transmission (4)
-------------------------------------------------------
Source: AIDS 98 treatment-access forum <treatment-access@hivnet.ch>
AIDS experts have known since 1994 that zidovudine (AZT) lowers the
risk of mother-to-child transmission of HIV by two thirds. But now, for
the first time, a major scientific journal publishes results showing
that this transmission can be prevented altogether (1).
As the researchers explain in the highly regarded journal AIDS, 31
children born to HIV-positive mothers in Switzerland were completely
protected from the virus by a combination of elective cesarean section
and AZT.
Carried out under the aegis of the CCRS/KKAF, the federal commission
responsible for co-ordinating all AIDS-related research in Switzerland,
the work results from a collaboration between the "Swiss HIV and pre-
gancy study" headed by Dr. Christoph Rudin of Basel, and the "Swiss
neonatal HIV study" led by Dr. Christian Kind of Saint Gall.
While mother-to-child transmission of HIV has assumed catastrophic pro-
portions in some developing countries, it also gives rise to concern,
though to a lesser extent, in developed countries. The fact is that, in
the industrialised countries, between 20 and 25% of children born of
HIV-positive mothers become infected with HIV if the delivery is natu-
ral and not accompanied by drug treatment of any kind. Most of the
children infected at birth survive up to schooling age, but a quarter
fall seriously ill in their first year of life and die before the age
of three.
The foetus is only rarely infected in its mother's womb, but during the
process of natural birth the risk of virus transmission is consider-
able. The main risks are: infected maternal blood being forced across
the placenta during labour; the new-born swallowing amniotic fluid af-
ter the waters break; or prolonged contact of the baby's delicate skin
with the mother's infectious fluids in the birth canal. Whence the idea
(which has been gaining in acceptance over time) of recommending a cae-
sarean delivery combined with a drug treatment.
This strategy still needed a scientific confirmation, which is brought
by the latest results published in AIDS. Out of 494 births to HIV-
positive mothers that the Swiss doctors monitored all over Switzerland,
31 took the cesarean-AZT combination. Not a single one of the resulting
31 children became infected!
Better still, since these results were drafted for publication the doc-
tors from Basel and Saint Gall have notched up further successes. So
far, they have followed a total of 72 mothers that took the combined
treatment, and not one of their children appears to be infected. Defi-
nite proof of this has been obtained for 42 of the offspring, and the
testing of the others is on-going.
The clinical procedure which enables such spectacular results - the
first in the world to be published - consists in carrying out the cae-
sarean before contractions begin and before the waters break. The drug
course is in three stages: for the 12 weeks preceding delivery, the
mother takes AZT pills five times a day; during labour, she is drip-fed
AZT continuously; and finally the same drug is administered orally to
the baby during the first six weeks of life. A further advantage of the
CCRS/KKAF-sponsored study is that it highlights the benefits of the two
forms of treatment. By comparing the instances where the caesarean took
place with or without AZT, Dr. Kind and Dr. Rudin's teams show for the
first time that the caesarean in itself has vitally important protec-
tive power.
It is therefore increasingly apparent that the caesarean-plus-AZT ap-
proach is set to become the number one method of treating HIV-positive
expectant mothers. Indeed, most major hospitals in Switzerland already
offer the combined treatment to their patients. Most doctors will also
discuss with the pregnant women the possibility of starting a combina-
tion of antiretroviral drugs including AZT during pregnancy, which
would be clearly better for her own health, but conferring the unknown
risks of additional drug exposure to the baby.
In order to ensure maximum chances of success, the mothers-to-be should
keep to the exact doses of AZT. Also, they must never breast-feed their
infants, as the virus might also be transmitted through their milk.
Dr. Kind goes a step further: "every year, we hear of cases where HIV-
infected babies are born to mothers who didn't know they carried the
virus. Therefore, it is absolutely essential that all pregnant women be
ascertained for HIV infection. Thus, if a woman discovers she is in-
fected, she will be able to get the best possible protection for her
child."
Other yet unpublished studies carried out in different countries seem
to lead to similar conclusions. Final doubts should be dispelled with
the completion of a broad-ranging global analysis by an American-
European collaborative group, which is to collate the results of some
fifteen studies across the world, including the one sponsored by the
CCRS/KKAF. A preview of the results of this global analysis, which
should be published before the end of the year, is expected at the 12th
World AIDS Congress, due to be held in Geneva from 28 June to 3 July.
(1) AIDS, 1998, 12: 205-210
Commission de Contr�le de la Recherche sur le Sida (CCRS)
3003 Berne Switzerland
Fax: +41-31-3238805
Distributed by:
Cedos International
7 rue du L�opard
1227 Carouge Gen�ve
Tel: +41-22-8273827
Fax: +41-22-8273829
---
Brian Pazvakavambwa MBChB, MPH
Regional Project Co-ordinator
Health Systems Research for Southern Africa
P.O.Box 2406 Harare / Zimbabwe
Tel: (W) +263-4-733696
(H) +263-4-882861
Fax: +263-4-733695
mailto:bpazva@harare.iafrica.com
http://www.healthnet.org/afronets/gtz-hsr.htm
--
Send mail for the `AFRO-NETS' conference to `afro-nets@usa.healthnet.org'.
Mail administrative requests to `majordomo@usa.healthnet.org'.
For additional assistance, send mail to: `owner-afro-nets@usa.healthnet.org'.