National guidelines need to be developed and implemented to ensure an adequate uptake of interventions known to reduce the risk of perinatal HIV transmission, according to a research paper published in the latest issue of Medical Journal of Australia.
About 10 per cent of people living with HIV infection in Australia are women, many of whom are in their reproductive years.
Dr Michelle Giles, an Infectious Disease Specialist from the Alfred Hospital, and her co-authors said three key interventions have been shown to significantly reduce mother-to-child transmission of HIV:
- Avoiding breastfeeding;
- Antiretroviral (ARV) therapy administered antenatally, during labour and to the newborn child; and
- Elective caesarean section.
Dr Giles said the high uptake of preventative interventions in women known to have HIV infection who are having children in Australia is encouraging, but no cause for complacency.
"Most importantly, the unknown number of women with HIV infection who are giving birth undiagnosed emphasises the need to ensure all women have access to HIV testing and the potential benefits for their health and the health of their babies," she said.
In the retrospective analysis, 367 live births were reported from 291 Australian women with HIV infection between 1982 and 2005. During the same period, 80 mothers were diagnosed with AIDS and 50 mothers died.
Dr Giles said nearly all the women elected not to breastfeed and most used some ARV therapy. Only the choice of having a caesarean appeared to be rejected by the study group.
The researchers analysed the use of zidovudine: 24 per cent of the women did not receive the systemic antiviral drug and 43 per cent of those who did not take it received other ARVs.
"Possible explanations for inconsistent use of zidovudine include contraindications such as concurrent use of stavudine, changing understanding of the recommendations by clinicians over time or patient refusal," she said.
The Medical Journal of Australia
is a publication of the Australian Medical Association.