The U.S. Public Health Service (PHS) guidelines were developed following a National Institutes of Health (NIH) study (ACTG 076) demonstrating that pregnant women can reduce the chances of transmitting HIV to their babies by as much as two-thirds if zidovudine (ZDV or AZT) therapy is initiated at 14 weeks or as soon as possible thereafter during pregnancy, continued through labor and delivery, and provided to the newborn for the first 6 weeks of life. According to CDC, this study offers another strong reason for women to seek early prenatal care, and as part of that care, to learn their HIV status.
"We have witnessed an unprecedented breakthrough in HIV prevention," said CDC Director David Satcher, M.D., M.P.H. "Our challenge is to translate the science into action and provide for any pregnant woman who may be HIV-infected the best chance of preventing transmission to her child."
To give babies the best chance for a healthy life, free of the AIDS virus, HIV-infected women must be reached as early in pregnancy as possible. To achieve that, PHS guidelines recommend routine HIV counseling and voluntary testing for all pregnant women -- a strategy that has already proven effective in several communities nationwide. In one inner-city hospital in Atlanta, Georgia, for example, 96% of women chose to be tested after being provided HIV counseling. If women do not receive prenatal care, or if for any reason their HIV status is unknown at the time of delivery, the guidelines also recommend that they be offered HIV testing for themselves or their babies shortly after birth.
An estimated 7,000 HIV-infected women give birth in the United States each year. Absent AZT therapy, the HIV transmission rate from mother to infant is about 15-30%. Based on this transmission rate, about 1,000-2,000 HIV-infected babies are born annually. "Ultimately the best way to prevent infection in babies is to prevent infection in women, so we must, and will, continue to focus on targeted prevention programs for women," said Helene Gayle, M.D., M.P.H., acting director of the CDC's newly established center for HIV, STD and TB prevention. "We must also reach pregnant women who are infected and give them the opportunity to improve their health and to protect their babies from perinatal transmission. To do this, we must begin by offering HIV counseling and voluntary testing to all pregnant women."
Gayle stressed, however, that counseling and testing alone cannot prevent mother-to-infant transmission. "Simply knowing a woman is infected will not prevent transmission of HIV to her baby. To reduce the chances of transmission, we must provide ongoing treatment and care, including AZT therapy." said Gayle.
Public health and medical professionals believe that voluntary testing is essential to establish the trusting patient-provider relationship necessary for women to make complex decisions about care for themselves and their babies and to follow through with treatment.
The U.S. Public Health Service Recommendations for HIV Counseling and Voluntary Testing for Pregnant Women are being published in the July 7, 1995, edition of the Morbidity and Mortality Weekly Report. CDC developed the guidelines in conjunction with federal, state, and local health agencies, health and medical organizations, and members of affected communities.
As public health and medical professionals prepare to implement the guidelines, the PHS is taking steps to ensure that they are rapidly adopted and to evaluate their effectiveness. "To prevent the continuing toll of HIV/AIDS on women and children, we must work together to develop policies and programs that provide women both opportunities for prevention and access to needed services and care," said Gayle.