A little over a month ago, the case of the Mississippi baby who was apparently cured of HIV thanks to an aggressive early antiretroviral treatment made world headlines. The media sold it as an enormously positive story that feeds hope in the ongoing fight against AIDS. But the other side of the coin is disheartening, because it conceals a major failure: that infected babies are still being born in developed countries such as the United States, which has all the necessary means at its disposal to avoid vertical (mother-to-child) transmission of HIV.
Advanced societies have sufficient knowledge about the mechanisms of vertical HIV transmission and the efficiency of the various strategies to prevent it; they also have the necessary resources to develop these strategies, which chiefly involve early identification of HIV in a pregnant woman. With a guaranteed diagnosis, we could prevent mother-to-child transmission almost completely, given the proper information and access to medical check-ups and treatment.
The zero-vertical-transmission goal is not utopian; it is reachable, at least in developed societies. Yet reality shows us that babies are still being born with the virus. As well as the Mississippi baby, eight cases were recorded in Spain in 2011. While they barely represent 0.3 percent of all new infections, eight cases are so many failures that should not be permitted in the kind of public health system that we, fortunately, have.
What we lack is the commitment to achieve zero mother to child infections¨
Thus, a new consensus on vertical HIV transmission drafted by the Gesida AIDS Study Group in partnership with the National Plan on AIDS Agency, the Spanish Society of Gynecology and Obstetrics, and the Spanish Society of Pediatric Infectology, recommends repeating HIV tests in the third trimester of gestation to prevent the infection from being discovered later on, or even during delivery, to be able to start antiretroviral treatment as soon as possible.
The importance of this therapy in prevention of mother-to-child infection is such that if no preventive treatment is undertaken, the transmission rate is between 12 and 30 percent in developed societies, and between 40 and 50 percent in nations without resources. Yet with antiretroviral therapy and proper clinical treatment, the transmission rates drop to 0.1 percent.
Most of the cases in our country in 2011 involved the children of mothers who had not been diagnosed with HIV, or were diagnosed late. In other words, the system failed due to the absence of early diagnosis. This should therefore be the first step in our overall goal of zero vertical transmission.
There are other challenges up ahead in connection with HIV patients who wish to have children. When the man is the only partner with the infection, the safest reproduction option, albeit an expensive one, is a semen wash and assisted reproduction techniques. If the woman is infected, then self-insemination is a simple and efficient method.
We have the necessary information and knowledge to reach zero vertical transmission in advanced societies. What we still lack is the determination and commitment to achieve it and to extend this success to developing societies, where the mother-to-child transmission rates should make us blush for shame.
Juan Berenguer is the president of Gesida.