Skip to main content

Prevention can mean no babies with HIV

By Mary Guinan, Special to CNN
updated 8:34 AM EST, Wed March 6, 2013
A girl, 1 hour old, receives an anti-retroviral drug in South Africa to prevent infection from the HIV virus carried by her mother.
A girl, 1 hour old, receives an anti-retroviral drug in South Africa to prevent infection from the HIV virus carried by her mother.
STORY HIGHLIGHTS
  • Mary Guinan one of the first to investigate AIDS, treated patients from 1981-1998
  • She has seen the progress of AIDS as a death sentence to people living with HIV
  • Guinan: Baby cured of HIV infection is great news, but infant didn't have to be infected
  • She says anti-retroviral drugs can easily prevent transmission from mother to child

Editor's note: Mary Guinan is a physician and former associate director for science at the Centers for Disease Control and Prevention. She was a member of the first CDC Task Force to investigate and identify the AIDS epidemic. That story is told in the book and movie "And the Band Played On." In 1998, she became Nevada state health officer and in 2004, became the founding dean of the University of Nevada-Las Vegas School of Public Health, renamed the School of Community Health Sciences.

(CNN) -- I took care of AIDS patients from 1981 to 1998 in a county clinic in Atlanta. By the time they showed up at the door, many of them had advanced disease. Most died within two years. Before they died, they suffered from untold painful physical conditions in addition to the unique brand of pain caused by the the pervasive social stigma of AIDS.

Without effective treatment of HIV, a physician couldn't offer much more than supportive care. Then, in 1995, a "cocktail" of three anti-retroviral drugs proved to be successful in fighting the virus -- not completely killing it, but reducing its numbers so its devastation of the immune system was minimized.

The treatment worked like a miracle. Patients got better and very quickly. Seeing the transformation of patients from close to death's door to living healthy lives was one of the most rewarding experiences I've had as a physician.

Dr. Mary Guinan
Dr. Mary Guinan
Become a fan of CNNOpinion
Stay up to date on the latest opinion, analysis and conversations through social media. Join us at Facebook/CNNOpinion and follow us @CNNOpinion on Twitter. We welcome your ideas and comments.



But the patients aren't cured. They must take drugs for their lifetime. Neither a cure for HIV nor a vaccine to prevent HIV has yet been developed.

Now, an HIV-infected baby who was treated with a combination of drugs from birth to 18 months and then not treated for a year was found to be free of HIV infection at 30 months. The child is considered cured.

This is the second reported HIV cure in history and the first in a child, and it is rightly making international news. We can all share the joy of a child cured and hope the treatment will bring a better life for infected babies in the future. Kudos to the clinician, Dr. Hannah B. Gay, whose expertise, instincts and treatment of the infant led to this remarkable outcome.

But there was another great advance against the HIV virus that did not make big headlines. A simple treatment with anti-retroviral drugs can prevent babies from being infected by their HIV positive mothers in the first place. Of course, a patient cure is much more visible than an infection prevented. Maybe that is why we celebrate cure in a way that we do not celebrate prevention.

Toddler's HIV cure offers global hope

Until the mid-1990s, pregnant women with HIV infection had a 30% chance of transmitting the infection to their newborn. A landmark study showed that treating HIV-positive pregnant women during their labor and delivery with intravenous zidovudine, or AZT, and then giving the infant AZT syrup orally for four to six weeks reduced the risk of HIV transmission to less than 2%. Successful prevention means the baby is free of HIV infection and will no longer need treatment.

We should also celebrate those babies who were not infected with HIV by virtue of treatment of mother and newborn with this drug regimen. Kudos to the thousands of clinicians who have treated HIV-infected pregnant mothers and their offspring.

Baby cured of HIV
Baby "cured" of HIV, are adults next?

How do we know the treatment was effective? We know only by the data meticulously collected by the Centers for Disease Control and Protection since AIDS was first recognized in 1981.

HIV transmission from mother to child during pregnancy, labor and delivery or breastfeeding is known as perinatal transmission. In 2012, the CDC reported that the combined mother/infant HIV treatment regimen resulted in a decline of perinatal transmission by more than 90% since the beginning of the HIV/AIDS epidemic.

AIDS in the '90s: 'I wasn't going to die miserably'

This incredible reduction was accomplished despite the fact that more women with HIV infection were giving birth. How far we have come.

Women with health care do not have a problem being tested for HIV. The problem lies with women who don't have health care and have not been tested. In 2005, the CDC recommended that if a women arrives in labor in the emergency room and has not had prenatal care, a rapid, 20-minute test for HIV should be done so preventive treatment can be started immediately.

Despite the existence of this treatment, babies are still born infected with HIV in the United States and worldwide. Prevention strategies are rarely perfect. That is why we need to have a Plan B for babies with HIV infection -- and the findings of Gay and her colleagues might be just that. The potential impact of this discovery will be far greater in developing countries -- especially in Africa, where thousands of HIV-infected babies are born each year.

Of course, what we desperately need to control HIV is a safe and effective vaccine for both infants and adults. Until then, let us celebrate each success. Each one gives hope that we will eventually conquer one of the most formidable of viruses.

Follow @CNNOpinion on Twitter.

Join us at Facebook/CNNOpinion.

The opinions expressed in this commentary are solely those of Mary Guinan.

ADVERTISEMENT
Part of complete coverage on
updated 2:31 PM EDT, Mon July 28, 2014
Megan McCracken and Jennifer Moreno say it's unacceptable for states to experiment with new execution procedures without full disclosure
updated 12:35 PM EDT, Mon July 28, 2014
Jeff Yang says it's great to see the comics make an effort at diversifying the halls of justice
updated 11:55 AM EDT, Sat July 26, 2014
Rick Francona says the reported artillery firing from Russian territory is a sign Vladimir Putin has escalated the Ukraine battle
updated 2:22 PM EDT, Sun July 27, 2014
Paul Callan says the fact that appeals delay the death penalty doesn't make it an unconstitutional punishment, as one judge ruled
updated 6:25 PM EDT, Thu July 24, 2014
Pilot Robert Mark says it's been tough for the airline industry after the plane crashes in Ukraine and Taiwan.
updated 11:10 AM EDT, Fri July 25, 2014
Jennifer DeVoe laments efforts to end subsidies that allow working Americans to finally afford health insurance.
updated 11:33 AM EDT, Sat July 26, 2014
Ruti Teitel says assigning a costly and humiliating "collective guilt" to Germany after WWI would end up teaching the global community hard lessons about who to blame for war crimes
updated 8:45 AM EDT, Fri July 25, 2014
John Sutter responds to criticism of his column on the ethics of eating dog.
updated 9:02 AM EDT, Fri July 25, 2014
Frida Ghitis says it's tempting to ignore North Korea's antics as bluster but the cruel regime is dangerous.
updated 2:50 PM EDT, Fri July 25, 2014
To the question "Is Putin evil?" Alexander Motyl says he is evil enough for condemnation by people of good will.
updated 2:03 PM EDT, Thu July 24, 2014
Laurie Garrett: Poor governance, ignorance, hysteria worsen the Ebola epidemic in Sierra Leone, Guinea, Liberia.
updated 9:49 AM EDT, Thu July 24, 2014
Patrick Cronin and Kelley Sayler say the world is seeing nonstate groups such as Ukraine's rebels wielding more power to do harm than ever before
updated 6:05 PM EDT, Wed July 23, 2014
Ukraine ambassador Olexander Motsyk places blame for the MH17 tragedy squarely at the door of Russia
updated 7:42 AM EDT, Thu July 24, 2014
Mark Kramer says Russia and its proxies have a history of shooting down civilian aircraft, often with few repercussions
updated 2:53 PM EDT, Thu July 24, 2014
Les Abend says, with rockets flying over Tel Aviv and missiles shooting down MH17 over Ukraine, a commercial pilot's pre-flight checklist just got much more complicated
updated 9:17 AM EDT, Thu July 24, 2014
Mark Kramer says Russia and its proxies have a history of shooting down civilian aircraft, often with few repercussions
updated 12:37 PM EDT, Thu July 24, 2014
Gerard Jacobs says grieving families and nations need the comfort of traditional rituals to honor the remains of loved ones, particularly in a mass disaster
updated 10:13 AM EDT, Thu July 24, 2014
The idea is difficult to stomach, but John Sutter writes that eating dog is morally equivalent to eating pig, another intelligent animal. If Americans oppose it, they should question their own eating habits as well.
updated 12:30 PM EDT, Wed July 23, 2014
Bill van Esveld says under the laws of war, civilians who do not join in the fight are always to be protected. An International Criminal Court could rule on whether Israeli airstrikes and Hamas rocketing are war crimes.
updated 10:08 AM EDT, Wed July 23, 2014
Gordon Brown says the kidnapped Nigerian girls have been in captivity for 100 days, but the world has not forgotten them.
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT