How can pregnant women prevent HIV/AIDS mother-child transmission?
By Maite Garmendia
Sonia* is restless all day long and has trouble sleeping at night but she hopes this will soon change. This 38-year old woman had to undergo treatment in Roosevelt Hospital in order to prevent HIV/ADIS transmission to her daughter Laura*, born a little over a year ago. The probability that the baby is an HIV carrier is less than 1%.
“The last test is scheduled for next week and then I will know if I have infected my child with HIV. The saddest and most painful part is to have to endure so much anguish for 9 months and one year and a half after childbirth in order to know if my daughter was not infected and is well. It’s many a sleepless night, going without food, and unimaginable anguish”, indicates Sonia. Therefore, she will only breathe at ease when she gets the last result. “At least she will be safe”, she adds.
Sonia was infected by her husband of five years. “He knew he was infected with HIV/AIDS but never told me. I found out when he became ill, and also that his first wife had been an AIDS victim. And I tested HIV positive”, she remarks.
Sonia, who already knew she was HIV positive but did not accept it, got pregnant shortly afterwards. “Due to the same lack of information and prevention and the desire not to accept that I had been infected, I got pregnant from my husband”, she recalls. He would die four months afterwards.
Prevent vertical transmission
While her husband was hospitalised, the pregnant mother was referred to the programme imple-mented by the Health Ministry and the United Nations Children’s Fund (UNICEF) in the Roosevelt Hospital for the prevention of vertical mother-child transmission. Sonia is among many women benefiting from this initiative, free of charge and operating since 2002. It is only developed in this hospital but there are plans to expand it to other maternities in the country.
“It is highly feasible to prevent mother-child transmission today if pregnant women attend prenatal consultation on time, their infection is detected and treatment provided”, points out Carlos Mejía, chief of the Infectious Diseases Unit of the Roosevelt Hospital.
Therefore, all pregnant women coming to this health centre are informed of the possibility of taking HIV tests. “Monday thru Friday, 15 to 18 patients take these tests every day”, Mejía explains. Since the programme started in the Roosevelt Hospital, more than 7,800 pregnant women have taken HIV tests, 5 in 1000 testing positive. This year, however, this figure increased to 7 x 1000 pregnant women infected, indicates Mejía.
What kind of treatment is applied once the virus is detected? The ideal situation is to detect the infection in the first three months of pregnancy. Anyway, starting the second quarter the mother is given antiretroviral medication and childbirth is through Caesarean section to prevent blood transmission; breastfeeding is not allowed and the infant is medicated for six weeks after child-birth.
In total, 92 seropositive women have gone through this programme –45 cases detected in Hospital and the rest referred from other places–, indicates Mejía.
The treatment is highly successful. Mejía goes on to explain that “if nothing is done, the probability of transmission is 30%. When mono therapy with AZT is applied, it falls to 8%. However, if the triple treatment –AZT, 3TC and Lopinavir-Ritonavir– is used (as in the Roosevelt Hospital), childbirth is by Caesarean section, the infant is not breastfed and treated, the incidence of transmission falls under 1%.
Out of 92 cases reported up to June 2004, 40 showed no transmission, 49 are still under analysis and pending childbirth, and there were 2 abortions. Only one infant was born infected because the mother entered the prevention programme only two weeks before giving birth, indicates Mejía.
Sonia thinks these figures are realistic. She hopes that Laura will be a healthy child and that she will live to see it. The programme not only aims at preventing vertical transmission but also at preserving mothers in order to avoid orphanhood. And so, after childbirth, Sonia continues to receive antiretroviral treatment because, as she says, “life must go on.”