Babies and HIV/AIDS

Every hour an estimated forty children die from AIDS.

Last year 420,000 children were newly infected with the HIV/AIDS virus. By the end of the year 2.5 million were living with the disease. Of the 2.1 million people who died of AIDS last year, one in every seven was a child.

Mother-to-child-transmission of HIV/AIDS, also called perinatal transmission, is increasing at an alarming rate. More than 60,000 babies are born worldwide each year with the HIV virus. Pregnant women are responsible for transmitting the virus to their unborn babies.

The most biologically intimate association between two individuals is that of a mother and the fetus developing inside her womb. It is also one of the most tragic consequences of HIV infection in women who become pregnant and transmit that deadly virus to their unborn children, said Professor Courtenay Bartholomew, Executive Director of the Medical Research Foundation of Trinidad and Tobago.

And according to the Centers for Disease Control and Prevention nearly 200 infants were infected with the virus in the United States of America annually. “Many of these infections involve women who were not tested early enough in pregnancy or who did not receive prevention services. Perinatal HIV transmission is the most common route of HIV infection in children and is now the source of almost all AIDS cases in children in the USA. Most of the children with AIDS are members of minority races and ethnicities.”

Professor Bartholomew said it’s a tragedy when the mother does not know that she is HIV-infected at the time of her pregnancy as is frequently the case, but it is a felony when she knows that she is HIV infected and still becomes pregnant while neither on treatment nor without taking other precautions.

He explained that the overall risk of transmission from an infected mother to her infant is around 30 percent. “In the early stages of infection and in the more advanced stages with severe immuno-suppression, the viral load is greater than at other times and transmission from mother to child is therefore considerably higher during these periods. Infection may be transmitted in utero or during the delivery process (intrapartum) as the baby moves down the birth canal and is bathed with the mother's blood. Infection may also be acquired after birth (postpartum) by breast feeding.”

He advised that HIV-positive mothers should not breast feed their babies, adding that about 23 per cent of HIV infections occur in utero and as early as the first trimester of pregnancy. Most transmissions, however, occur at the time of delivery or during the birth process.

He noted that in Trinidad and Tobago “all mothers attending antenatal clinics were tested for HIV antibodies (with their consent). This being so, we have found that 8 per cent of the mothers first became aware of their HIV positivity this way. This is interesting. Once they are tested positive they are then referred to the Medical Research Centre where we assess the immunological status of the mothers (CD4 counts) and their viral loads. Depending on those levels, we then treat the mothers at a certain time in their gestation period and treatment continues during labour, after labour and onwards. In other words, we now treat both mother and child. We use the World Health Organisation's (WHO) therapeutic recommendation for mother to child transmission. To date we have treated 203 mothers and only 7 (3.4 per cent) of their babies have been infected. But even that is not good enough.

“We are now considering a more aggressive approach by treating the mothers with triple therapy earlier in their pregnancy although we are very concerned that since non-compliance of therapy increases with time, we may theoretically be putting the mothers at risk of developing drug resistance in time to come the earlier we begin treatment. Whether our concern is valid would only be determined in comparative long-term studies. In the meanwhile, we are aiming for a zero transmission of virus from mother to child without compromising the mother in the long-term.”

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