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Tests on moms in labor can cut AIDS in babies
Rapid tests to detect the virus that causes AIDS can be administered successfully to women in labor and contribute to dramatic reductions in the number of babies born with infections, according to a major new study conducted in Chicago and other cities.
The findings--to be presented Sunday at an international AIDS conference in Bangkok--open another significant avenue for preventing the transmission of AIDS from mothers to infants and stopping the devastation this disease can wreak on children.
"We now know we can intervene at the last possible moment--just before a woman gives birth--and make a significant difference," said Dr. Mardge Cohen, co-author of the study and director of the Women's HIV Research Center at Stroger Hospital.
"Testing all women who don't know their HIV status when they arrive in labor at a hospital and providing treatment if they are positive should become the new standard of care."
The results show that when infected women in labor receive AIDS drugs, the percentage of babies born with HIV, the virus that causes AIDS, is cut in half--from 25 percent to less than 12 percent. Women qualified for therapy if they had never been tested for HIV or if test results weren't available.
If their moms received therapy, babies also got six weeks of drug treatment, which helped keep HIV at bay.
The Journal of the American Medical Association is publishing the study this week in a special issue devoted to AIDS.
Nationwide, nearly half the 300 HIV-infected babies born each year are delivered by mothers unaware that they carried the virus.
Before rapid tests became available, it wasn't feasible to try to ascertain HIV status when women arrived at hospitals in labor. Traditional blood tests take 28 hours or longer to yield results --more time than it takes most women to give birth--compared with over 20 minutes for rapid tests.
Now, however, hospitals across the country are preparing to implement rapid tests for women on the verge of giving birth who didn't get prenatal care or HIV tests--many of them poor, immigrants and minorities.
"Our goal is to eliminate maternal-to-infant transmission of AIDS," said Frances Margolin, a researcher at Chicago's Health Research and Education Trust, an affiliate of the American Hospital Association. The trust recently launched a four-year project to prepare hospitals across the country to administer rapid HIV tests.
In Illinois, a new law that goes into effect next month mandates that all women who are pregnant be offered HIV tests and given counseling when they are seen by medical professionals.
As many as 30 percent of pregnant women show up at Illinois hospitals in labor without knowing their HIV status. They, too, will get counseling and the offer of an HIV test under the new law, passed last year.
"This is an incredibly important safety net for the hardest-to-reach women and their babies. We should be able to prevent virtually all pediatric HIV cases in the state with this," said Dr. Ann Bryant, a fellow at Northwestern's Feinberg School of Medicine who is helping coordinate the state's Perinatal Rapid Testing Implementation Initiative.
The vast majority of women--85 percent--who are offered HIV tests while in labor agree to take them and get therapy if they prove positive, according to the new JAMA study conducted at Cook County Hospital and five other hospitals in the Chicago area.
Ten hospitals in Atlanta, Baton Rouge, Miami, New Orleans and New York also participated in the research conducted over a two-year period ending in November 2003. Rapid HIV tests were just becoming available during this period.
The results are likely to be even more important internationally than in the United States, where the number of babies born annually with HIV has plummeted by more than 75 percent over the last dozen years, largely because of effective new drug therapies given to women during pregnancy.
Such therapies are expensive, however, and most pregnant women in Africa and developing countries do not routinely get them.
Worldwide, more than 2,000 children are infected with HIV every day.
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