Oct. 13, 1999 (Washington) -- Counseling and testing for HIV should be a universal component of prenatal care, according to Catherine Wilfert, MD, speaking here at the 69th annual meeting of the American Academy of Pediatrics. "When you tell women, 'If you are infected, we can treat you and reduce the chance of your baby becoming infected,' most women want to be tested," she told a room full of pediatricians.
"By definition, all pregnant women have had unprotected sex. Therefore, they should be offered counseling, and should be tested for HIV, as a routine part of their [prenatal] care," Wilfert, professor of pediatrics at Duke University in Durham, N.C., tells WebMD. She says that even though most physicians accept that HIV counseling for pregnant women should be a part of prenatal care, there is no consensus on exactly who should receive counseling. "[The solution is to] make the HIV counseling routine, because it helps individual women feel less stigmatized," she says.
The ability to prevent HIV transmission from the mother to the child at the time of birth with HIV medications is the impetus for universal testing, says Wilfert. Statistics show that the number of births per year to HIV-infected women has remained stable for over 10 years, approximately 6,000 to 7,000. Further, women are a growing category of people with HIV disease, making up 25% of reported AIDS cases. In 1998, 38% of those women acquired their disease from heterosexual contact, and 29% acquired it through injectable drug use, she notes.
However, the number of new pediatric AIDS cases has declined 70%, from 1,600 in 1992 to 382 in 1998. The number is down 80% among children 0 to 5 years old, according to Wilfert. "This decline reflects the value of [HIV] treatment of infected pregnant women, and our knowledge ... that it interrupts transmission [at birth]," she says.
Yet, the data are not completely precise, says Wilfert, since they reflect older guidelines that only required the reporting of AIDS and not HIV infection. Because HIV therapy slows the progression to AIDS, and because not all states require reporting of all HIV cases, accurate data on the number of HIV-infected women and children are not available, she says. AIDS occurs when someone infected with HIV develops other infections or medical problems that are due to having HIV. Someone can be infected with HIV for a long time before actually becoming sick and developing AIDS.
Women need to be educated about their vulnerability to becoming infected with HIV through heterosexual intercourse, says Theresa Felten, MD, PhD, who works as an independent contractor for Social Security Disability in Lakeland, Fla. "If a woman's partner has been unfaithful, she shares the sexual disease history of all her partner's partners," she tells WebMD in an independent interview. "The risks may be almost as if she had had 40 partners herself."