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Study: AZT, Caesareans reduce HIV spread to infants

June 27, 1998
Web posted at: 9:42 p.m. EDT (0142 GMT)
Mother and child
Nine out of 10 babies born with HIV are in sub-Saharan Africa  

In this story:

GENEVA (CNN) -- Choosing to have a Caesarean delivery combined with taking the drug AZT may be the best way to keep HIV-positive pregnant women from transmitting the deadly virus to their newborns, researchers said Saturday.

A study of nearly 2,000 French women showed the treatments reduced the rate of mother-to-child HIV transmissions by nearly two-thirds.

The researchers, led by Dr. Laurent Mandelbrot of the Cochin- Port Royal Hospital in Paris, announced their findings at a news conference the day before the opening of the 12th World AIDS Conference in Geneva.

"HIV-positive women who receive AZT and deliver by elective Caesarean have a less than 1 percent risk of having an infected baby," Mandelbrot said.

Mandelbrot emphasized that the Caesarean delivery must be performed before the woman goes into labor and while her membranes are still intact.

Timing is the key

Most scheduled Caesareans are done at around 38 weeks into the pregnancy to ensure that the infant is not born prematurely. However, Mandelbrot acknowledged that even with careful planning, up to 30 percent of expectant mothers may deliver early.

Timing is crucial, because HIV is transmitted either during birth, late in pregnancy through the placenta which nourishes the fetus, or through the woman's membranes into the amniotic fluid which surrounds the fetus.

Operating room
A study shows if pregnant women who are HIV-positive combine AZT therapy and elective Caesarean sections, they can reduce the chances of infecting their newborns  

Mandelbrot also conceded that Caesareans may not be available in developing countries that need it most, because health care may not be advanced enough to offer women a low-cost, low-risk Caesarean.

But, he added, the procedure is a routine operation in Brazil, South Africa and Thailand.

"Unfortunately, nine out of 10 babies infected with HIV are in sub-Saharan Africa ... and mostly in places where this is just not the way to go," he said.

Ninety percent of the more than 30 million people infected with HIV live in developing nations. The theme of this year's AIDS conference is to find better ways to give those nations access to today's more advanced AIDS and HIV therapies, which are readily available in Europe and the United States.

The study

Among the 902 women in the study who were given AZT (zidovudine), developed by Glaxo Wellcome Plc, 6.6 percent who delivered their infants by natural childbirth passed on the virus to their babies. Of the 133 women who took AZT and chose a Caesarean delivery, only one baby was infected with the virus.

Among women who did not take AZT therapy, the method of delivery made little difference in the transmission of HIV to the infant, the researchers said.

Mother-to-child, or vertical transmission, is the leading cause of HIV infection in infants, particularly in developing nations.

The study is published in the Journal of the American Medical Association.

Correspondent Al Hinman and Reuters contributed to this report.

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