Eliminating Mother-To-Child Transmission of HIV In the U.S. Is Possible, Study

Posted on December 29, 2016

By: Alex Kopel

From HIVEqual.org

March 27th, 2017

The U.S. has made huge gains in the last few decades in reducing mother-to-child transmission (MTCT) of HIV, according to a new study published in Jama Pediatrics. Scientists found that only 69 babies were born with the virus in the U.S. in 2013 compared to 216 in 2012.

A late HIV diagnosis for expectant mothers, a lack of antiretroviral medication, and other missed opportunities for preventive measures are all factors that can lead to MTCT of HIV. Thus, due to an increasing rate of HIV testing among women, there has been a dramatic drop in the rates of transmission.

While only 38 percent of mothers knew of their HIV status before pregnancy in the years from 2002-2005, this figure increased to 50 percent of women knowing their status in the years from 2010-2013.

Prospective mothers knowing their status is the most critical step in reducing transmission, which is why many doctors feel that an HIV test should be mandatory and highly encouraged in the first trimester of pregnancy. Once expectant mothers know their status, they can then start antiretroviral therapy (ART). Pregnant woman adhering to treatment only have a 1-2 percent chance of passing HIV on to their babies.

Even expectant mothers who aren’t diagnosed with HIV until their third trimester, can still reduce the risk of MTCT by beginning late treatment. And even during labor it is still possible to avoid MTCT by giving an HIV-positive mother medication and IV drug treatment to protect the baby from exposure during delivery.

“We have made great strides in decreasing HIV in mother-to-child transmission in the USA,” said Dr. David Rosenthal, the director of the Center for Young Adult, Adolescent and Pediatric HIV in New York. “In New York State alone in the 1990s we had more than 500 new cases of mother-to-child transmission a year, but now in 2015-2016 we had an 18-month period with zero new mother-to-child transmissions.”

About 150,000 babies are diagnosed with HIV each year from around the world, down from a peak of more than 600,000 per year in the 1990s.

“The idea of eliminating mother-to-child transmission of HIV is officially on the table,” said Dr. Deborah Cohan, the director of the Perinatal HIV Clinic at the University of California, San Francisco.

Yet while the U.S. as a whole made great strides in reducing mother-to-child transmissions, there were specific demographics that did not fare as well as the general population. Even though African-Americans compose only 17 percent of the general population, about 66 percent of babies born with HIV belonged to African-American women, between the years 2002 to 2013, according to the study.

More than 80 percent of MTCT during this time period were from Latina and African-American mothers, which underscores the high rate of HIV prevalence among these populations. Now that we have the scientific tools, the only reason that MTCT continues to exist has to do with access. There must be more testing and treatment facilities for these key populations, according to the authors of the study.

Additionally, five Southern states in particular, Florida, Texas, Georgia, Louisiana and Maryland, took the brunt of the MTCT cases, accounting for 38 percent of the new cases of HIV in the U.S. from 2012 to 2013.

The stigma of HIV can still lead to otherwise avoidable MTCT. Doctors often fail to suggest an HIV test for pregnant mothers because they do not want to offend a mother, or they assume that the mother is not at risk. Similarly, many prospective mothers believe that HIV is “something that happens to other kinds of people.” These types of stereotypes lead them to believe that they don’t need to be tested. It’s easy to forget that anyone from any background can get HIV.

Completely reducing mother-to-child transmissions is crucial for ending the HIV epidemic and now, thanks to advancements in medicine, they are entirely avoidable. Antiretroviral treatment (ART) taken by the mother during pregnancy and ART for the infant six weeks after birth are enough to ensure that all children are born HIV-free.

“Together, these methods are incredibly effective in decreasing mother-to-child transmission,” Rosenthal said. “In order to make this happen, we have to help ensure mothers receive good medical care early in their pregnancy, and we need to ensure that mothers of all races and ethnicities receive the same outstanding medical care we offer.”