HIV Testing for Pregnant Women

* The dramatic success of Zidovudine (AZT) in reducing the rate of HIV transmission from infected pregnant women to their infants provides encouragement and hope to the entire international AIDS community. It is the first study performed which shows that drug therapy can prevent HIV infection in exposed individuals. More important, each protected infant will be spared a long, costly and painful disease.

The most important implication of this study is the necessity for routine screening of all pregnant women for HIV infection. Never before has there been a therapeutic intervention to protect infants from the fatal consequences of maternally transmitted HIV. Because of these dramatic improvements in life expectancy, the Pediatric AIDS Foundation strongly recommends routine prenatal screening and counseling of pregnant women as the standard of care. Lifesaving preventive treatment cannot be ethically denied because of ineffective HIV screening.

There could be no more satisfying result than the prevention of HIV infection. Indeed, the cost of research in pediatric HIV/AIDS is justified by the result of this single study, which has the potential of preventing HIV infection in thousands of infants throughout the world.

The success of the reported clinical trial has not resolved all issues concerning the prevention of HIV transmission. The trial enrolled asymptomatic HIV-infected pregnant women. Will AZT work in women who are sicker or who receive less vigorous treatments? Can preventive treatment be made in developing countries where the cost of AZT is prohibitive? Can similar treatment with AZT prevent HIV transmission in health care workers after accidental inoculation (needle sticks)? Ongoing trials and continued research must address these issues.

Undoubtedly, there will be future issues concerning treatment failures. But failures must not be attributed to lack of public-health diligence in detecting HIV-infected pregnant women and offering to them early treatment and counseling regarding future pregnancies. It is now time to support strong public-health recommendations aimed at reducing the number of children who die with AIDS.

E. RICHARD STIEHM MD

Professor of Pediatrics, UCLA School

of Medicine, Health Advisory Board

Member, Pediatric AIDS Foundation