Testing targets HIV in infants

The AIDS baby - that tender symbol of a savage, indiscriminate illness that could attack the innocent as well as the reckless -- is becoming a medical memory, an image fading like a picture of a polio-stricken child.

Down to just a handful of cases each year of infants born with HIV, state health officials now want to take a final step to eradicate baby AIDS, stopping transmission of the virus from mother to child. This week, the N.C. Commission for Public Health voted to impose testing requirements in hopes of stopping mother-to-child transmission entirely.

Last year, just one baby was born in the state with HIV, the virus that causes AIDS. Soon, there may be none.

"Our goal is to not have any babies born in our state with HIV infection," State Health Director Leah M. Devlin said. "There is no excuse for it. There are a lot of available medications and other things we can do that can reduce the transmission to infants, and we need to put in place every tool that we have to do that."

According to the Centers for Disease Control and Prevention in Atlanta, about 1,700 infants were born in this country each year in the 1990s with human immunodeficiency virus. New anti-retroviral drugs, increased screening and other interventions have reduced that to fewer than 150 cases per year.

Devlin said two to four babies are born each year in North Carolina infected with the virus; 36 were diagnosed in the decade from 1997 to 2006.

Mothers with HIV/AIDS can transmit the disease to their children in the womb, during birth and through breast-feeding. Without medical intervention, an infected mother has about a 25 percent chance of giving the disease to her baby.

If doctors know the mother is infected, they can reduce the chance of transmission to the baby to less than 3 percent by giving the mother anti-retroviral drugs during pregnancy, performing a Caesarean section instead of waiting for a vaginal birth and preventing breast-feeding. The CDC says most cases of newborn HIV/AIDS are a result of a lack of testing, and the agency has recommended that all pregnant women be tested twice -- during the first prenatal visit and again in the third trimester.

Dr. Jeff Engel, the state epidemiologist, said the vast majority of pregnant women in North Carolina get tested for HIV/AIDS, most as part of their routine prenatal care. Some women don't get adequate prenatal care, however, or decline the testing, which is voluntary.

Testing to be required

On Wednesday, the N.C. Commission for Public Health, which makes rules for medical practitioners in the state, voted to require HIV/AIDS testing in any woman who comes to a medical facility ready to deliver and for whom there is no record of an HIV test during pregnancy. The rule change must be approved by the state's Rules Review Commission. It's unclear when it would take effect.

The health commission was acting on September recommendations by the CDC designed to reduce the spread of HIV/AIDs, still a leading cause of death and illness in the United States. The disease first came to light in Haiti in the 1980s, about the same time cases were being uncovered in the United States. First a disease of gay men, AIDS spread to other populations. It's now expanding fastest among African-Americans in the South. As a result of improved drug treatments, while the the incidence of HIV continues to rise, the onset of AIDS is slowing.

HIV among pregnant women has been especially vexing, because of the opportunity to transmit the disease to an unborn child, and because methods of interrupting that transmission are highly reliable.