The HIV Breakthrough, Prenatal Care, and Hope for the Future

On Sunday, news quickly spread that a young child in Mississippi had been cured of HIV. As a newborn, the child tested positive for HIV and the specialist, Dr. Hanna Gay, administered a high dosage of drugs within hours of the child’s birth. After continuing on antiretrovirals for about a year, the child and mother stopped treatment. When they resurfaced months later, the mother stated she had continued the child’s treatment. Surprisingly, the child’s HIV test came back negative. A series of increasingly sensitive tests showed the virus was undetectable. This discovery could overhaul the way mother-to-child (also known as perinatal) transmission is treated. If the results are reproducible, the drug dosage and combination has the potential to stop the 300,000 cases of HIV in newborns reported annually worldwide. What’s unique about this case is that the mother received no prenatal care prior to entering the hospital in labor. Generally, pregnant women with HIV require special treatment considerations in order to prevent mother-to-child transmission. Doctors and expectant mothers weigh the costs and benefits of continuing treatment, keeping in mind that transmission does not usually occur until late in pregnancy or during delivery. This mother and child enjoyed none of the protections of drug treatment until after the birth of the child—and yet they are the center of one of the most promising HIV breakthroughs.

About 25% of infants born to mothers who do not take AZT and other drugs during pregnancy will be infected with HIV. But if the mother undergoes treatment while pregnant, only 2% of newborns will be test positive. Now, with the possibility of mega doses of drugs after birth reducing infection rates even more, we may be working toward eliminating mother-to-child transmission altogether.

Prenatal care is crucial. But in Mississippi, where the child was born, the Kaiser Family Foundation reports that women of color who give birth in the state are far less likely to receive prenatal care until late in their pregnancy or until they go into labor.

Lack of care until late in pregnancy or lack of prenatal care altogether is highest in American Indian (27.8%) and black mothers (22.8%), followed by Hispanic (23.0%) and Asian mothers (14.1%). Compared to the 9.1% of white women who go without care until their child is close to full-term, the inequity is disheartening. And the numbers are not unique to Mississippi. These prenatal care patterns are consistent with the patterns of the country at large. Paired with the CDC’s findings that black women have the highest rate of mother-to-child infection (9.9 per 100,000 births), ethnic and racial disparities in prenatal care matter.

This possible turning point in treatment means that even if an expectant HIV-positive mother receives no prenatal care and gives birth to an HIV-positive child, the child may have a fighting chance to live HIV free. We know that ethnic and racial minority women do not receive prenatal care at the same rates as white women. This potential new treatment option gives hope that HIV-positive women who do not receive prenatal care—women who are disproportionately from ethnic and racial minority groups—may be able see their children live HIV-free.