November 2005
Pregnant women need HIV testing to protect themselves and their babies
All pregnant women need to know their HIV status to help protect themselves and their unborn babies, says a maternal-fetal medicine specialist at the Medical College of Georgia.
"The reason this is important is there are about 300 babies born every year in this country with HIV infection," says Dr. Andrew W. Helfgott, chief of the MCG Section of Maternal-Fetal Medicine. "If everybody were to get tested and that information was readily available, we could probably decrease that number to 10 or 20."
He will discuss why and when pregnant women need HIV testing during a live Centers for Disease Control and Prevention broadcast and Web cast, "Revised Recommendations for HIV Screening of Adults, Adolescents and Pregnant Women in Health-Care Settings," Nov. 17 from 1-3 p.m.
The MCG high-risk pregnancy expert got interested in preventing HIV transmission in the mid-1980s, before HIV or AIDS were even identified. "I was an obstetrics and gynecology resident in Brooklyn in 1984 when I saw my first case. These women were getting sick; their babies were getting sick. They were dying; their babies were dying. We didn't know what was going on."
Fortunately in the subsequent two decades, improvements in the ability to diagnose and treat HIV infection have dramatically reduced the cases of full-blown AIDS but have not done much for HIV infection rates, says Dr. Helfgott.
"With the medications and therapies we have now, HIV has become more like the diabetes model of chronic care," he says. Still, the stigma of HIV infection lives on, so many people, even some mothers-to-be, are resistant about knowing their own status.
Dr. Helfgott, who was medical director of maternal-fetal medicine and director of the Regional Perinatal Intensive Care Unit at Sacred Heart Health System in Pensacola, Fla., before joining the MCG faculty in January, helped improve HIV testing in pregnant women in Florida. In fact, Florida is now among the states that regularly test pregnant women for HIV as part of routine lab work unless the woman asks that it not be done.
He's working with the Georgia Department of Human Resources to help raise awareness of the need for testing among health care providers in his new home state.
"Everybody should know their HIV status, not just pregnant women," says Dr. Helfgott. But with about a 25 percent chance that an HIV-positive woman will transmit the infection to her baby, pregnant women become a high priority, he says.
About 85 percent of those transmissions take place during labor and delivery. HIV-positive women should avoid breast-feeding, which also carries the risk of infection.
Ideally a woman knows her HIV status before she gets pregnant, says Dr. Helfgott. Current recommendations are for testing early in pregnancy and again in the third trimester, at about 32 weeks gestation, because of the potential for becoming HIV- positive during pregnancy. "We actually have picked up women who tested negative early in pregnancy and subsequently tested positive," he says, noting the virus has a long incubation period of three to six months.
If all else fails, a relatively new test that produces results in about 20 minutes as opposed to three days, can be done in the labor and delivery suite. Even that point, doesn't stop the state of New York, where the baby is automatically tested if the mother has not been, Dr. Helfgott says.
"It's not about making people do things they don't want to, but the fact of the matter is this is a largely preventable disease in babies and the only way you are going to be able to take care of yourself and prevent your baby from infection is to know what your status is, and that is what this whole CDC conference is about," he says.
If a pregnant woman is HIV-positive, she can be put on a cocktail of drugs that lowers the virus load in her body to essentially undetectable levels, which helps protect her from developing AIDS and reduces the risk of transmission to her baby, Dr. Helfgott says. C-sections also are believed to reduce the risk. Babies born to an HIV-positive mother are put on AZT, the first drug approved to treat HIV, within 48 hours. These steps reduce the risk of transmission from 25 percent to about 9 percent.
"I tell HIV-positive women there is a risk but I will do whatever I can to help you have a successful pregnancy and get you home as healthy as possible with a healthy baby," Dr. Helfgott says.