Changing policy could prevent mother-to-infant HIV transmission

Pregnant women are currently not required by ministry regulations to undergo HIV testing prior to delivery.

By JUDY SIEGEL-ITZKOVICH
baby good 88 (photo credit: Courtesy )
baby good 88
(photo credit: Courtesy )
The Health Ministry's policy of not requiring pregnant women - especially those with higher risk of being HIV carriers - to undergo screening for the virus should be changed to reduce the risk of mother-to-infant transmission, according to experts at Hadassah University Medical Center in Jerusalem's Ein Kerem. Pregnant women are currently not required by ministry regulations to undergo HIV testing prior to delivery. The US Centers for Disease Control has for the last two years recommended universal "opt-out" screening for HIV among all pregnant American women; it is offered to all, but not forced on the minority who refuse it. This policy has been endorsed by the World Health Organization and UNAIDS, and is being implemented in several US states, including New York, New Jersey and Arkansas, several Canadian provinces and in a growing number of African countries. Head of Hadassah's AIDS center, Prof. Shlomo Ma'ayan, together with his colleagues, who include pediatricians and gynecologists, voice their opinion in the latest issue of the Israel Medical Association Journal (IMAJ). They are backed up by an editorial written by specialists at the Kaplan Medical Center in Rehovot in the same issue. The Hadassah team studied the cases of 35 HIV-positive women who gave birth at their hospital to 45 children between 1996 and 2006. Thirty-nine of the infants were born to Ethiopian immigrants, of whom there were 31 participating in the study. Of the 35 women, 30 knew they were carrying HIV, but the rest (all Ethiopian immigrants) didn't. Two women breast-fed, and neither knew they were HIV carriers. Eleven of the Ethiopian babies were vaginal births and 28 were delivered by cesarean section - 18 by choice and ten due to emergencies. Three of the 26 Ethiopian women who had known they were HIV positive refused to undergo antiretroviral treatment to minimize the risk of transmission to their babies. All of the non-Ethiopians agreed to give birth by cesarean. Four of the 45 babies were born with or (due to breast-feeding) soon became infected with the AIDS virus. Mother-to-infant transmission of HIV is much more likely in women who deliver vaginally, breast-feed and don't receive a "cocktail" of antiretroviral medications, while the risk is much reduced in women who have cesareans, bottle-feed and take such pills, the authors wrote. "The substantial proportion of women - all Ethiopians - unaware of being HIV positive at delivery, together with the significantly higher HIV transmission in that group compared to women who knew their HIV status," the authors concluded, "call for a revision of the current [Health Ministry] opt-in policy for prenatal HIV screening." They added that evidently, "the opt-in policy that is currently implemented in Israel, mainly among Ethiopian women, has little impact on HIV testing among these women." The Kaplan specialists, Drs. Zev Sthoeger and Daniel Elbirt, maintain that mother-to-infant transmission can be effectively eliminated if pregnant women are screened; carrier status is diagnosed early; carriers undergo cesarean delivery, receive a full course of antiretroviral therapy and do not breast-feed. This, they wrote, "should be strictly performed by a coordinated team of health care workers, family physicians, pediatricians, gynecologists and HIV experts." Health Ministry officials are on vacation, but when asked years ago by The Jerusalem Post about instituting such a policy, senior officials said they opposed it for financial and other reasons.