Mothers, Babies and AIDS
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was 23 years ago, and subsequent tests on the blood we collected indicated none of the mothers or infants we studied were infected with AIDS. But today, in 1999, 2,000 Pamwani newborns will contract AIDS from their mothers. This number, from a single hospital, is 10 times the number of babies who will be diagnosed with AIDS in the entire United States.
Why? Because 1 in 5 of all mothers in Nairobi, 20 percent, are infected with HIV, compared with 1 in 300, 0.3 percent, of American mothers. And the rate of maternal-infant transmission is 30 percent in Kenya, but only 3-5 percent in the U.S.
There are many factors for the disparity: lack of prenatal diagnosis, more advanced diseases and fewer cesarean sections, among them. But the two most important factors are the lack of AIDS drugs and prolonged breast-feeding.
Several years ago, a U.S. government-supported study showed that giving the antiviral drug AZT to the mother during pregnancy and labor and to her infant after birth decreased the rate of AIDS transmission from 25 percent to 7 percent. Today in the U.S., all HIV-infected mothers receive AZT (and other antivirals) during pregnancy and the transmission rate is down to 3-5 percent. For the 6,000 HIV-infected mothers in the U.S., only 200 of their babies will become infected. This is the most dramatic therapeutic triumph in the battle against AIDS to date, but AZT is unavailable for most African mothers. It is just too expensive.
All Pamwani mothers breast-feed their infants, often for as long as 24 months. We now know that breast-feeding, particularly beyond six months, increases the chance of AIDS transmission by about 25 percent. Thus, we are faced with a tragic Catch-22: Breast-feeding protects against most infections, but for those infants born to mothers infected with AIDS, this otherwise life-sustaining practice can be deadly. Breast is not best for these infants.
What can be done? For starters, we can use new, simplified, rapid AIDS tests to identify infected mothers-to-be. We can use shorter and less expensive drug regimens to prevent HIV transmission. And we can wean the high-risk infants at 6 months of age if a safe, alternative formula can be identified. How long must we beat the drum on this issue before such practices can be put in place? I don't know. But there is where we must begin. So back to Africa we will go.
E. Richard Stiehm is chief of the Division of Immunology, Allergy and Rheumatology at Mattel Children's Hospital and codirector of the Los Angeles Pediatric AIDS Consortium.