2005 Study by Mohala Tucker

SAMPLE EXCERPT:

In other words, both of these studies from the late 1990s point investigation in the direction of noting that the presence of infected maternal blood due to customary tearing and dilation within the birth canal during parturition may actually be responsible for infecting the infant during the actual process of childbirth, even after the infant has remained infection-free for nine months within the womb. This particular fact would have revolutionary implications in terms of reducing transmission from mother to infant, and indeed it is responsible for the decision on the part of Mohala Tucker Besser et al. (2005) to conduct their study exclusively on "HIV-positive women undergoing elective caesarian section at full term" (489). As a result, the amniotic fluid studied would be from a woman about to give birth, while the method of giving birth would be the one least likely to permit HIV transmission according to other factors beyond actual transmission within the womb.

Mohala Tucker Besser et al. (2005) additionally follow the most significant recommendation to come from Mofenson (1997) by placing the mothers involved in the study on significant doses of anti-retroviral drugs including zidovudine and nevirapine. However despite the great advances that had been made between 1987 and 1997 in identifying various risk factors (like breast feeding and natural childbirth) that significantly increased the likelihood of HIV transmission, it is nonetheless astonishing that for nearly twenty years the evidence presented by precisely one case history reported by Mundy et al. In 1987 was allowed to suggest that amniotic fluid remained a significant vector of transmission of the virus to those infants infected in utero. It is worth noting that in the same year that Mohala Tucker Besser et al. conducted this present study, Magder Mofenson Paul et al. (2005) conducted a similar assessment based on a ten-year-long "Women and Infants Transmission Study" intended to provide a comprehensive survey of what precisely was known about the process of transmission between mothers and unborn infants (87). In the study by Magder Mofenson Paul et al. (2005), it was established that the most significant factor for in utero transmission was apparently low birth weight of the infant, while various other factors became involved with "intrapartum transmission" such as "duration of membrane rupture" thus suggesting that amniotic fluid might actually be protective rather than a vector of viral transmission (94-5). The other significant fact of this long-term study was the observation that the increase in knowledge about actual transmission had affected the study while in progress: by 2000, the proportion of infections that occurred in utero had increased, suggesting that increased knowledge of how to prevent the viral transmission during actual childbirth had a significant effect.

The ultimate conclusion reached by Mohala Tucker Besser et al. (2005) is that "although the exact mode of HIV transmission in utero remains speculative, our data suggest that, in normal, uncomplicated pregnancies, before the onset of labor or rupture of the amniotic membranes, the amniotic fluid is free of HIV" (490). This therefore renders the earlier case history presented in 1987 by Mundy Schinazi Gerber et al. A probable example of contamination by maternal blood of the sampled amniotic fluid (or possibly a result of increased accuracy in HIV testing in the ensuing two decades). Mohala Tucker Besser et al. (2005) note that their results cannot be held true in cases involving actual vaginal birth, because of the flood of "inflammatory mechanisms" by the mother's body that induce labor and soften and dilate the cervix (490-1). They suggest that it is perhaps these hormonal agents which pose the greatest risk for transmission to the infant if the mother chooses (against all scientific evidence) to "deliver vaginally" (491).

References

Lin HH, Kao JH, Hsu HY, Mizokami M, Hirano K, Chen DS. (1996). Least microtransfusion from mother to fetus in elective cesarean delivery. Obstetric Gynecology 87: 244-248.

Magder LS, Mofenson L, Paul ME, Zorrilla CD, Blattner WA, Tuomala RE, LaRussa P, Landesman S, Rich KC. (2005). Risk factors for in utero and intrapartum transmission of HIV. Journal of Acquired Immune Deficicency Syndrome 38: 87-95.

Mofenson LM 1997. Mother-child HIV-1 transmission: timing and determinants. Obstetrics and Gynecology Clinics of North America 24: 759-784.

Mohlala BK, Tucker TJ, Besser MJ, Williamson C, Yeats J, Smit L, Anthony J, Puren…