Cana­dian ba­bies get­ting HIV from moms now al­most zero: stud­ies

Cape Breton Post - - HEALTH/ADVICE - BY SH­ERYL UBELACKER

Canada has vir­tu­ally elim­i­nated the in­ci­dence of moth­ers pass­ing HIV to their in­fants at birth, pri­mar­ily be­cause of high rates of pre-natal test­ing and ready ac­cess to drug treat­ment that sub­dues the in­fec­tion, re­searchers say.

In 2014, there was only one case of mother-to-child HIV trans­mis­sion in Canada, con­tin­u­ing a decade-long down­ward trend, said Dr. Jason Bro­phy, chair of the Cana­dian Pe­di­atric and Peri­na­tal AIDS Re­search Group (CPARG), which has been track­ing cases since 1990.

“The World Health Or­ga­ni­za­tion def­i­ni­tion of elim­i­na­tion is less than two per cent trans­mis­sion, and that’s where we are right now,” said Bro­phy, an in­fec­tious dis­ease spe­cial­ist at the Chil­dren’s Hos­pi­tal of Eastern On­tario in Ot­tawa.

The find­ing was among data from three stud­ies by CPARG’s peri­na­tal HIV sur­veil­lance pro­gram pre­sented Wed­nes­day at the 8th In­ter­na­tional AIDS So­ci­ety con­fer­ence on HIV Patho­gen­e­sis, Treat­ment and Preven­tion in Van­cou­ver.

Each year, an av­er­age of about 200 ba­bies are born in Canada to women di­ag­nosed with HIV, said Bro­phy, not­ing that in the 1990s, be­fore the ad­vent of an­tiretro­vi­ral drugs, 84 per cent of HIV-pos­i­tive moms-to-be were di­ag­nosed af­ter they got preg­nant.

“Whereas in the more-re­cent era, like 2008 to 2013, only 10 per cent were di­ag­nosed dur­ing their preg­nancy,” he said, with 90 per cent know­ing they had HIV be­fore be­com­ing preg­nant and al­ready on in­fec­tion-damp­en­ing drug treat­ment.

“And what that means is women are get­ting di­ag­nosed and put on treat­ment ... and then choos­ing to have ba­bies.”

But even among women who learn they are HIV-pos­i­tive dur­ing their preg­nancy, ba­bies are rarely at risk of get­ting the in­fec­tion, as long as the moth­ers are able to get on an­tiretro­vi­rals for at least a month be­fore giv­ing birth, Bro­phy said.

“I re­as­sure moms that for women who’ve been on med­i­ca­tion and are well-sup­pressed and ev­ery­thing goes fine at de­liv­ery ... I tell them: ‘Don’t worry about your baby, your baby will be fine.

“I’ve seen hun­dreds of ba­bies at this point and none have been in­fected. It’s only the ba­bies where mom’s virus isn’t sup­pressed at de­liv­ery - be­cause of not enough time on treat­ment or not know­ing the di­ag­no­sis - where there’s a real risk of trans­mis­sion.”

Bro­phy also pre­sented a study Wed­nes­day that looked at the coun­tries of ori­gin of HIV-pos­i­tive women who gave birth in Canada be­tween 1990 and 2013. Of al­most 3,900 women, 54 per cent were for­eign-born, and of those, 71 per cent em­i­grated from Africa.

In the first half of the 1990s - be­fore the use of an­tiretro­vi­ral drugs - the largest group of HIV­pos­i­tive moth­ers came from French-speak­ing Haiti, with many of them set­tling in Que­bec.

Since 2008, the largest group of HIV-in­fected moth­ers has come to Canada from Ethiopia, Congo, Zim­babwe and Nige­ria.

“The in­ter­est­ing pat­tern we see in this is the source coun­tries over time re­ally re­flect what’s go­ing on in the world around us,” said Bro­phy. “There are many coun­tries of con­flict and we get an uptick in the num­ber of women from those coun­tries as peo­ple flee.

“Canada’s peri­na­tal HIV pop­u­la­tion re­ally re­flects global trends.”

Yet the Cana­dian Peri­na­tal HIV Sur­veil­lance Pro­gram stud­ies show that African moms-tobe have a lower risk of trans­mit­ting HIV to their in­fants at birth than their Cana­di­an­born coun­ter­parts, per­haps be­cause HIV test­ing is re­quired for immigration, he said.

Joel Singer, a pro­fes­sor at UBC’s School of Pop­u­la­tion and Public Health, co-au­thored a study show­ing that in 2014, 97 per cent of all HIV-pos­i­tive women in Canada had re­ceived an­tiretro­vi­ral drugs be­fore giv­ing birth.

Also of note, he said, is that HIV-in­fected abo­rig­i­nal women and IV drug abusers - who pre­vi­ously had higher rates of mother-to-in­fant trans­mis­sion - now have treat­ment rates com­pa­ra­ble to other preg­nant women with the virus.

“We’re fi­nally reach­ing all of these groups who were, for one rea­son or another, more marginal­ized,” Singer said from Van­cou­ver.

“I think the over­all mes­sage is that Canada has done quite well (but) we have to con­tinue to be vig­i­lant, par­tic­u­larly with groups that were pre­vi­ously not get­ting the proper an­te­na­tal care.

“We can’t rest on our lau­rels.”

CP PHOTO

Dr. Jason Bro­phy, an in­fec­tious dis­ease spe­cial­ist at the Chil­dren’s Hos­pi­tal of Eastern On­tario in Ot­tawa, is shown in a hand­out photo. Canada has vir­tu­ally elim­i­nated the in­ci­dence of moth­ers pass­ing HIV to their in­fants at birth, pri­mar­ily be­cause of high rates of pre-natal test­ing and ready ac­cess to drug treat­ment that sub­dues the in­fec­tion, re­searchers say.

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