County Issues Alert Over Increase in HIV-Positive Babies

With seven new cases of HIV reported among children in January, Los Angeles County health officials issued a public alert Monday urging pregnant women to be tested and treated to forestall these largely preventable infections.

By taking anti-AIDS drugs during pregnancy and avoiding breastfeeding after birth, HIV-positive women can cut the chances of passing the virus to newborns to less than 8%, said Dr. Toni Frederick, chief epidemiologist with the county’s pediatric HIV project.

None of the seven cases, which were identified in January by the county Department of Health Services, involved babies infected last month. Four of the infants were born last year and the other three were born within the last five years, Frederick said.

Because the state does not require doctors and hospitals to report new HIV cases, the county must seek out this information, which can result in delays.

“These are babies that are sick and will carry the HIV on now through adolescence and young adulthood,” Frederick said. “It’s a pretty long course of disease that’s entirely preventable.”

Some mothers of the seven infected babies declined tests for the human immunodeficiency virus, which were offered during prenatal visits. Others had not received prenatal care or said they had been tested but were negative.

Those most at risk of not receiving prenatal care--including HIV tests--include women who are drug addicts, incarcerated, homeless, non-English speakers, undocumented immigrants, uninsured or teenagers, said Dr. Jonathan Fielding, the county’s director of public health.

Even if a woman receives no prenatal care, hospitals can take steps to prevent HIV transmission to newborns. If the virus is identified in a woman during childbirth--or immediately afterward--her baby can be given drugs during the first 24 hours of life, reducing the risk of infection.

If the test results are known soon enough, doctors can give the woman antiretroviral drugs during delivery. But some hospitals are not able to provide lab results in time to make a difference.

In one recent case at Los Angeles County-USC Medical Center, the positive results came back too late to treat the infant and prevent infection, said Dr. Andrea Kovacs, who heads the hospital’s program for HIV-positive women, children and adolescents.

Troubled by that case, Kovacs said she would like to begin offering rapid testing at the hospital, which would provide results within an hour compared with the current four days. “We would have treated the baby if we knew the mom was HIV-positive,” she said.

In New York and elsewhere, state law requires hospitals to test newborns for HIV, even if parents do not give consent. California requires no tests, Frederick said.

California physicians are required to counsel pregnant women and offer them testing, but women have the right to refuse.

“People are still not aware that they can totally prevent this terrible disease in their newborn by getting treated prenatally,” Frederick said. The number of perinatal HIV infections in Los Angeles County fell sharply after hitting 18 in 1996. The figure held steady from 1998 to 2001 at four to five cases per year.

Kovacs attributed some of the success to the hospital’s outreach efforts. Of the 200 HIV-positive women who got prenatal care in the last five years at County-USC, none gave birth to infected infants.