July 18th, 2014
When I began working in AIDS support and education in 1993 (we used the term AIDS all the time, as it was a reality), pregnancy was something women were mourning. Once diagnosed, they were told by doctors flat out, “Don’t get pregnant.” Back then, we didn’t know as much as we do now about HIV, pregnancy, and healthy babies. What we did know is that about one in four babies born to moms with HIV would get it themselves.
In 1994, the results of the ACTG 076 clinical trial came out. Pregnant women using AZT (which would never be prescribed as a single drug nowadays) were significantly less likely to have babies with HIV than those who didn’t take it. Only 8% of these babies were born infected.
Fast forward to combination therapy, and the transmission risk for pregnant women’s babies is about 1%. Doctors routinely support women to plan their pregnancies and deliver healthy kids. With advances in HIV therapy for the moms, they can expect to see their kids grow up. Moms can be so healthy they may even become grandmothers, depending on if and when their kids become parents.
And now we’re even considering whether babies can be cured. The “Mississippi Baby” hit the headlines first. Her mom hadn’t had prenatal care, so her HIV status was unknown until birth. She was given combination therapy within 31 hours of birth, and her mom was later lost to follow-up. Miraculously, when the mom reappeared in the health care system, her daughter still tested negative even though she hadn’t been on the treatment for some time. Sadly, she’s now four years old and has shown signs that HIV is rebounding. She’s been put back on treatment.
Canadian kids treated immediately following birth are showing similar uninfected statuses, but they have not been taken off medication. Another who had side effects did go off treatment, and HIV established itself firmly, unfortunately. These results are making scientists really explore what HIV treatment can do for newly infected people. Could catching HIV soon enough and treating it aggressively be a way to a cure?
There will be more on this at AIDS 2014, so keep your eyes out. Babies may lead the way!