HIV Screening in a Rural Antenatal Clinic

Satish Doshi (Doctor)

Akluj, India

Introduction

The acquired immunodeficiency syndrome (AIDS) epidemic has proved to be a major stumbling block in achieving health improvements in many regions. In the developing world, it is estimated that 2.5 million HIV-infected women give birth each year¹ with the risk of maternal-child transmission of the infection a real concern. The aims of the current study were:

1. Assess the prevalence of HIV among pregnant women attending a private nursing home in the rural town of Akluj, India (population 40,000); and

2. Identify HIV-infected women with a view to providing medical termination of pregnancy where appropriate.

Patients and Procedures

Seven hundred and eighty antenatal cases were tested for HIV (using INSTI and TRIDOT) between January 1, 1998 and June 30, 1998 when they came for routine antenatal check-up. At the same time, other routine investigations such as haemaglobin measurement and blood typing were completed. Testing HIV-positive provoked confirmation of status using the Western Blot method and testing of the women's husbands.

Results

Of the 780 women screened, 20 (2.56%) tested HIV-positive. Each of these women's husbands also tested HIV-positive: 7 (35%) who worked locally and 13 (65%) who worked at distant locations. The greatest proportion of HIV-positive patients were in the 21-23 year age group (see table 1).

Seven HIV-positive cases underwent medical termination of pregnancy before 8 weeks gestation while all babies delivered to HIV-positive mothers were subsequently found to be HIV-positive.

Conclusion

This study suggests a high incidence of HIV infection in the rural region surveyed. [Editor's note: Maharashtra is indeed one of the high prevalence states for HIV infection; the figure of 2.56% in this rural population matches that of the urban population in this region (see page 17).]

Reference

1. Graham WJ, Newell ML. Seizing the opportunity: collaborative initiatives to reduce HIV and maternal mortality. Lancet 1999;353:836-839.

Three-pronged Strategy to Prevent MTCT of HIV

KR Damania
RH Merchant
J Karkare

Mumbai, India

Introduction

Prior to the present study¹ being undertaken, the usefulness of zidovudine (AZT) in reducing mother-to-child transmission (MTCT) of HIV had already been proven in the ACTG 076 trial. There also existed circumstantial evidence subsequently substantiated for the benefit of elective caesarean section (ECS) to reduce transmission rates. The risk of HIV transmission through breastfeeding was well documented.

The aim of the study, therefore, was to evaluate the efficacy of a three-pronged intervention strategy based on the above in reducing perinatal transmission of HIV:

1. Antenatal AZT (100 mg four times daily for 6 weeks prior to delivery).

2. ECS at term.

3. No breast feeding; neonatal AZT (12.5 mg twice-daily for 6 weeks).

Patients and Procedures

Three hundred and twenty HIV-infected pregnant women were counselled about choice of intervention(s). Fifty-nine (18.5%) accepted all three interventions (group 1). Of the remainder, 178 (55.6%) did not accept any intervention (group 2), while 83 (25%) accepted one or two interventions (group 3); of the latter, 71% opted for no breastfeeding as the only intervention. In terms of patient characteristics, all three groups were identical.Children were followed-up with HIV antibody testing at 9, 12, and 18 months.

Results

No children tested seropositive in group 1 compared with just over one-third in group 2 and one-fifth in group 3 (see table 1).

There was a single case of wound evisceration in a patient belonging to group 1. That this woman had an abnormal CD4:CD8 cell count emphasised the need for caution in performing ECS normally a very safe procedure in this institute in immunocompromised individuals.

Conclusions

This preliminary study suggests that a three-pronged intervention strategy to reduce MTCT of HIV is effective. Antenatal AZT in lower dosages and shorter periods may be offered in resource-poor settings.

Reference

1. Damania KR, Merchant RH, Karkare J. A three-pronged strategy to prevent mother to child transmission of HIV infection. Presented at: 42^nd All India Congress of Obstetrics and Gynaecology, Hyderabad, India, December 27-30, 1998.