Preventing Mother-to-Child Transmission of HIV/AIDS in Developing Countries: What You Need to Know

 

Hi, my name is [PRESENTER NAME]. I’m [PRESENTER ROLE]. Welcome to “Preventing Mother-to-Child Transmission of HIV/AIDS in Developing Countries: What You Need to Know.”

If a woman is HIV positive and becomes pregnant, there are varying risks that her child will contract HIV during the pregnancy, more commonly during childbirth, or while breastfeeding. If an HIV positive woman takes no steps to protect her child from HIV and does not breastfeed, there is a 15-30% chance that her child will contract HIV. If she also breastfeeds, the risk of transmission increases to 20-45%.

However, if an HIV positive woman follows her doctor’s instructions, including the use of appropriate antiretroviral medications (ARVs), it is possible to markedly reduce the risk of HIV transmission. If you are pregnant or thinking about having a baby, the information in this video could save your child’s life, so please watch the whole video and listen carefully.

Pregnant women in developing resource-poor settings who are HIV positive often do not have access to the medical treatments and nutrition available in developed countries. This video talks about additional ways pregnant HIV positive women in developing resource-poor settings can decrease the risk of transmission of the virus to their baby. There is a separate video on this site for pregnant HIV positive women in developed countries who generally have access to health care services and antiretroviral medications.

Get Tested for HIV

If you know you are pregnant or are thinking about having a baby, see a doctor. The next step to protecting your baby from transmission is to find out if you are HIV positive. You may be HIV positive and not know it. All pregnant women should be tested for HIV, no matter how far along they are in their pregnancy. Governments and Non-Governmental Organizations typically provide free HIV testing.

Comparing the Use of Antiretroviral Medications (ARVs) in Developed and Developing Countries

In a developed country, a doctor may recommend that a pregnant woman start taking antiretroviral medications immediately if she is not already on them. A doctor is especially likely to recommend this if the woman is showing symptoms of clinical AIDS, her CD4 cell (or immune cell) count is low, or the amount of virus in her body is high. Going on ARVs can improve a woman’s own health as well as reducing the chance that her child will contract HIV during pregnancy, or, more commonly, during childbirth. If a pregnant woman is already on ARVs, her doctor will likely keep her on them, except for efavirenz (also known as Stocrin or Sustiva), which has been shown to cause problems for a developing fetus. Even if a doctor doesn’t recommend that a pregnant woman start ARVs immediately, they will recommend going on ARVs after the first trimester. The reason for this is to minimize the effects of ARVs on a fetus while it is in the most critical early developmental stages in the womb. If a doctor prescribes ARVs, it’s extremely important to take every dose of the medications on schedule. A separate video on this web site called “Adherence for Life” explains more about why taking every dose of ARV medications on schedule is so important.

The likelihood of going on ARVs if you are pregnant and HIV positive in a developing country will vary depending upon what part of the world you live in. In a developing country there is a limited number of ARVs used in pregnancy and for a shorter course. Often, this regimen is not the optimal for protecting the baby but is often the only resource available, and it is much better for the baby than doing nothing. Efforts are being made to increase the availability of the best antiretroviral medications to people in the developing world.

According to the World Health Organization,(quote) “All the controlled clinical trials on MTCT [Mother to Child Transmission] prevention have demonstrated the short-term safety and tolerance of short-course ARV regimens used for a limited period of time in pregnancy and/or in the infant for preventing MTCT [Mother to Child Transmission]. However, information is still lacking on the effects of short courses of ARV drugs to prevent MTCT on the long-term health of the infected mother (and that of her infant) or on future ARV treatment options, but research is ongoing.” (end quote) The important thing for an HIV positive pregnant woman to understand is that following her doctor’s advice and the current guidelines, including the use of ARVs where available, is the best way for her to prevent mother to child transmission of HIV.

Scheduled Caesarian Section

There is evidence that the risk of mother-to-child HIV transmission may be lower if the child is delivered via a scheduled Caesarian section rather than by a natural vaginal delivery. However, if a woman is on ARVs and her viral load – or amount of virus in the body – is less than 1,000, vaginal delivery is as low a risk as Caesarian section – approximately 1%. Of course, Caesarian sections carry their own increased risks of infection for the mother and possible respiratory complications for the child. Caesarian sections are only an option when trained medical personnel and sterile medical treatment facilities are available. In the developing world, Caesarian sections are usually not an available or safe option due to the lack of access to trained personnel and/or facilities and the high risk of infection due to unsanitary conditions.

ARVs During and After Labor and Delivery

Every HIV positive woman should receive intravenous AZT during delivery, once her water has broken, but this is not usually available in developing countries. Alternatively, oral ARVs are given to the mother during delivery and to the infant after delivery. In developing countries, there is still much work to be done to provide pediatric (or child) dosages of ARVs to those infants most in need.

Concerns About Developing Resistance in Mother and Infants After Short Courses of ARV Medication

Concerns have been raised that when a mother takes a single dose of ARV medication to reduce the risk of mother-to-child transmission, she is at an increased risk of developing a resistant strain of the HIV virus, making it more difficult to treat her in the future. Though it’s true that a woman who takes a single dose of nevirapine has an increased risk of developing an HIV strain with resistance to some HIV medications, the overall risk to the mother is small while the benefit to the child is great, so where better treatment regimens are not available, single-dose nevirapine is still recommended to reduce the risk of mother-to-child transmission of HIV. More recently, it has been shown that adding a short course of additional ARVs to the single dose of nevirapine can reduce the risk of the mother developing resistance. Therefore, this treatment is preferred whenever possible. Evaluating these issues is complicated. The best answer of course is to try to make top-quality ARV treatment readily available to all who need it. Until then, women should talk to their doctor about what options they actually have and try to get access to the best treatment possible.

Breastfeeding in Resource-Poor Settings

If the mother is HIV positive and breastfeeds her baby, there is a risk of mother-to-child transmission of HIV. In the world’s poorest regions, when comparing breastfeeding versus the use of infant formula, breastfeeding is often necessary despite the risk of HIV transmission because the water can be unsafe to drink and formula is scarce. It has also been shown that mixing the use of formula and breastfeeding is worse for the baby than either exclusive breastfeeding or exclusive use of formula.

Testing the Baby for HIV

All babies born to HIV positive mothers should be tested to determine whether they are HIV positive. Babies born to HIV positive mothers are tested for HIV differently than adults. Adults are tested by looking for antibodies to HIV in their blood. A newly born infant keeps antibodies from its mother, including antibodies to HIV, for many months after birth. Therefore, an antibody test given before the baby is 1 year old may be positive even if the baby does NOT have HIV. For the first year, babies are tested for HIV by looking for the virus, and not by looking for antibodies to HIV. When babies are more than 1 year old, they no longer have their mother’s antibodies and can be tested for HIV using the antibody test. If after the 1st year the baby tests negative they are considered HIV negative.

If Your Child is HIV Positive

If your child turns out to be HIV positive, talk with your doctor about what treatments are right for them. In the developing world, with the appropriate treatment and nutrition, HIV positive infants may be able to live a very healthy life.

Important Things to Remember

Being pregnant and HIV positive in a developing country can pose many risks for your child. Knowing your HIV status is the first step toward reducing your child’s risk of contracting HIV. Hopefully in the future every pregnant HIV positive mother in developing countries will have the same access to health services and treatment as most women in the developed world. In the meantime, as a woman in a developing country, by doing the best you can with the resources available to you to prevent the transmission of HIV to your child, you can play an important part in the fight against HIV. This is [PRESENTER NAME].

 

REFERENCES

http://www.who.int/hiv/pub/mtct/guidelines/en/

“Antiretroviral Drugs for Treating Pregnant Women and Preventing HIV Infection in Infants: Guidelines on Care, Treatment and Support for Women Living with HIV/AIDS and their Children in Resource-Constrained Settings”

 

http://www.aidstruth.org/cohen-hivnet012.php

HIV TRANSMISSION: Allegations Raise Fears of Backlash Against AIDS Prevention Strategy

Science 24 December 2004

Vol. 306. no. 5705, pp. 2168 - 2169

by Jon Cohen

 

http://www.aidsnews.org/2004/12/nevirapine-ap.html

Nevirapine Misinformation: Will It Kill?

by John S. James

 

http://www3.niaid.nih.gov/news/newsreleases/2005/332005_nevirapine.pdf

Reports on nevirapine threaten public health

NATURE MEDICINE VOLUME 11 | NUMBER 3 | MARCH 2005

p. 245