Alberta - IV and pregnancy
To have a healthy baby, pregnant women in Canada are encouraged to seek prenatal care. An aspect of this care involves testing the mother for exposure to infectious diseases, including syphilis, gonorrhea, Chlamydia and HIV. All of these infections can be transmitted to the baby.
According to researchers at the Hospital for Sick Children in Toronto, between the years 1984 and 2005 there have been 2,206 infants in Canada whose HIV infection has been confirmed.
These days, at least in high-income countries, there are fewer cases of HIV positive babies being born to women with HIV. For instance, in Canada, the proportion of infants infected at birth has dramatically decreased-from 40% in 1994 to 4% in 2005.
To reduce the risk of transmitting HIV from mother to baby, here are several steps that can be taken:
offering HIV testing and counselling to pregnant women
HIV treatment for pregnant women who have tested positive. Treatment should suppress viral load as much as possible-the lower the viral load, the lower the risk of HIV transmission.
delivery of the baby through a Cesarean-section
treatment of the infant with AZT for several weeks after birth (a form of post-exposure prophylaxis, or PEP)
no breastfeeding, as HIV can be transmitted through breast milk
By taking all of these steps, the risk of perinatal HIV transmission can be reduced to about 1%.
HIV testing
Researchers in Alberta have recently reported that province's findings from its prenatal HIV testing program. The findings suggest that women who decline the option of HIV testing are three times more likely to have HIV than women who agree to test for this virus.
Study details
According to the researchers, HIV testing is routinely performed as part of prenatal care in Alberta unless the woman decides to "opt out." About 45,000 pregnant women undergo HIV testing every year in Alberta, with relatively few women testing positive. The study team decided to focus its work on pregnant women who declined HIV testing. Researchers obtained blood samples from these women and tested them anonymously for HIV.
Trends in time
Between August 2002 and January 2005, about 3.6% of pregnant women in Alberta declined HIV testing. However, the good news is that fewer women refused an HIV test over time, as follows:
2002: 4.3% of pregnant women refused an HIV test
2003: 4.1% of pregnant women refused an HIV test
2004: 3.6% of pregnant women refused an HIV test
The research team noted that among pregnant women who declined an HIV test the risk of their blood being positive for HIV was three times greater than that among women who agreed to be tested for HIV.
Among pregnant women who agreed to HIV testing, 46 tested positive for HIV. HIV was a new diagnosis for 22 of these women.
Proper counselling
Prenatal HIV testing programs provide important opportunities to reduce the risk of HIV transmission from mother to child. According to a research team at the Hospital for Sick Children, counselling pregnant women about HIV testing should include the following points:
The reason for testing is that diagnosis and therapy might not only improve the mother's health, but will also radically change the outcome of the baby's health, as transmission to the baby can be eliminated in most cases.
Most women cannot be absolutely certain that their partners have not been exposed to HIV infection.
Future research
More research is needed to find out why some pregnant women decided to opt out of routine HIV testing. Findings from such a study could be used to help educate women who want to have a baby about the benefits of HIV testing.
-Sean R. Hosein
REFERENCES:
1. Magder LS, Mofenson L, Paul ME, et al. Risk factors for in utero and intrapartum transmission of HIV. Journal of Acquired Immune Deficiency Syndromes 2005 Jan 1;38(1):87-95.
2. Jamieson DJ, Read JS, Kourtis AP, et al. Cesarean delivery for HIV-infected women: recommendations and controversies. American Journal of Obstetrics and Gynecology 2007 Sep;197(3 Suppl):S96-100.
3. McDonald C, Lambert J, Nayagam D, et al. Why are children still being infected with HIV? Experiences in the prevention of mother-to-child transmission of HIV in south London. Sexually Transmitted Infections 2007 Feb;83(1):59-63.
4. Perinatal HIV Guidelines Working Group. Public Health Service Task Force Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States. November 2, 2007 1-96. Available at: http://aidsinfo.nih.gov/ContentFiles/PerinatalGL.pdf. Accessed [15 November, 2007]
5. Plitt SS, Singh AE, Lee BE, et al. HIV seroprevalence among women opting out of prenatal HIV screening in Alberta, Canada: 2002-2004. Clinical Infectious Diseases 2007 15 Dec; in press.
6. Shrim A, Garcia-Bournissen F, Murphy K, et al. When pregnant women are not screened for HIV. Canadian Family Physician 2007 Oct;53(10):1663-5.
Created on: 12/18/2007
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