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Frerichs, R.R. More on Preventing Mother-to-Child HIV Transmission in Thailand. 

SEA-AIDS Network, November 19, 1998.

R.R. Frerichs Posting

The current New England Journal of Medicine (NEJM) brings findings on still another AZT study, suggesting further cost and effectiveness savings with short-term treatment of the mother. While some health officials in Asia may be reluctant to test mothers for HIV antibodies if the benefits to their offsprings are not clearly apparent, this new research should assure them that much can be done, even in countries with few financial resources. The important implication of the NEJM article is that once infected pregnant women are detected, preferably earlier but acceptable even if at the time of delivery,then AZT treatment should be started as soon as possible.

Have others in Asia besides our Thai colleagues experienced similar success with routine HIV detection among pregnant women, especially with the use of rapid tests? If so, please share your findings.

"AZT after delivery can prevent infant HIV" News Release. Wednesday November 11, 1998.

A course of the drug AZT can help prevent HIV transmission from mother to child even if the drug is first administered during labor and delivery, or first given to the infant 48 hours after birth, according to a report in the November 12th issue of The New England Journal of Medicine. The findings suggest that weeks of prenatal AZT (zidovudine) treatment -- which is known to substantially reduce the risk of transmission -- is the best but not the only way to reduce the risk of infected mothers transmitting the virus to their infants. The findings are especially good news for the treatment of HIV-infected women in developing countries, which may not be able to afford weeks of expensive drug treatment for pregnant women. "The drug-related cost of such prophylactic treatment of infants would be a fraction (less than 1/10) of that for even a short course of maternal treatment, "according to an editorial by Dr. Kenneth McIntosh, of Children's Hospital, Boston, Massachusetts.

In the study of 939 infants exposed to HIV between 1995 and 1997, the HIV transmission rate was 6.1% when the mother was treated prenataly, 10% where the mother was treated during labor and delivery, and 9.3% for infants treated in the first 48 hours of life. The transmission rate was 18.4% for those infants treated on the third day of life or later, and 26.6% for those not treated with AZT at all. There are a number of reasons the women may not have received AZT during pregnancy, according to the report. "Some women may not receive prenatal care, whereas others who do receive prenatal care may not be counseled or offered HIV testing," according to the report. 

The new study suggests that even if a woman had no prenatal care, rapid HIV testing of a newborn may still prevent transmission of the virus to an infant, reported lead author Dr. Nancy Wade of the AIDS Institute in Albany, New York, and colleagues. 

Study co-author Dr. Guthrie S. Birkhead told Reuters Health there is a potential role for rapid HIV testing in the delivery setting. "This has already been discussed somewhat in the medical literature... and our study shows that, indeed, there may be some benefit of doing rapid testing in the delivery setting." He pointed out that because many women are not tested for HIV during prenatal care, "it makes sense to try to identify these women at the time of delivery." But to reduce perinatal HIV transmission "to the greatest extent possible, a combination of efforts is needed to ensure that all pregnant women receive HIV counseling and are tested for HIV and, if positive, receive prophylaxis with zidovudine, alone or in combination with other antiretroviral agents," the authors conclude.

SOURCE: The New England Journal of Medicine 1998;3391409-1414,1487-1468.