2005 Study by Mohala Tucker Besser Et

¶ … 2005 study by Mohala Tucker Besser et al., conducted upon HIV-positive pregnant women who are about to undergo voluntary caesarian section to give birth. Mohala Tucker Besser et al. used a sample population to study whether or not HIV was present within the amniotic fluid of these pregnant women, and discovered that -- contrary to a previous study published in 1987 -- it was not.

Additional relevant studies -- including the original 1987 Lancet publication by Mundy Schinazi Gerber et al., and further studies involving viral transmission between mothers and newborns and specific risk factors for HIV transmission in prenatal and perinatal situations -- are examined in conjunction with Mohala Tucker Besser's 2005 study. The finding has implications for preventing HIV transmission between mothers and newborn infants, and confirms the growing clinical consensus that elective caesarian section remains one of the most reliable ways to reduce viral transmission from an infected mother to the infant.

Mohala Tucker Besser et al. (2005) conducted a study regarding one of the remaining mysteries about HIV transmission. It has been long established that an HIV-positive pregnant woman is capable of infecting her unborn child with the virus, however this does not always happen. Indeed Mohala Tucker Besser et al. give the most accurate current estimate of infection rates for the unborn child at being about ten to fifteen percent of such pregnancies (488). Obviously this issue is significant for a number of reasons.

For a start, pediatric HIV is a massive public health concern: Mohala Tucker Besser et al. quote World Health Organization statistics that estimate approximately ten percent of new HIV infections in developing countries are children, and over ninety percent of these cases represent perinatal transmission. Even in the United States, over ninety percent of pediatric HIV infections are due to perinatal transmission. Mohala Tucker Besser et al.

(2005) are engaged in the specific examination of whether or not the amniotic fluid of the pregnant woman is involved in these cases of perinatal transmission. What is most significant about this is that they are revisiting an issue which had been reviewed earlier in the 1980s at more or less the height of the AIDS epidemic. At that point in time the American team of Mundy Schinazi Gerber et al.

(1987) published an article in The Lancet claiming to have isolated the active form of the human immunodeficiency virus in amniocentesis samples taken from an HIV-positive pregnant woman's amniotic sac at 32 weeks (459). As Mohala Tucker Besser et al. (2005) explain about this earlier publication, it was restricted to "describing a single patient" and more importantly "maternal blood contamination of the amniotic fluid was not excluded" (488).

As a result, this earlier publication -- which represented the entirety of prior literature on the subject of amniotic fluid involvement in perinatal HIV transmission -- really does not have the status of scientific inquiry. As a result, Mohala Tucker Besser et al. organized the present study to present a more consistent overall examination of the question of amniotic fluid involvement. In addition to the implicit response to the earlier publication by Mundy Schinazi Gerber et al., however, Mohala Tucker Besser et al.

are also able to benefit from advances in relevant knowledge in terms of how this particular study should be structured. For example, ten years after Mundy Schinazi Gerber et al., Mofenson (1997) published a survey on the state of existing knowledge regarding the "pathogenesis of perinatal transmission" in order to assist with the effort to minimize transmission and thus reduce the number of pediatric AIDS cases worldwide (759). Mofenson's summary emphasizes that certain facts are distinctly responsible for a vast reduction in the number of cases of mother-to-child HIV transmission.

Breast feeding, for example, is implicated in a significant number of previously identified mother-to-child infections. But more significantly perhaps the rate of transmission to the newborn infant is dramatically reduced if the mother undergoes birth by voluntary caesarian section rather than natural childbirth. Indeed not restricting the virology to HIV, the work of Lin Kao Hsu et al.

(1996) studying the actual process of "microtransfusion" during different types of childbirth concluded that generally speaking that the level of any mother-to-fetus viral transmission is least in "elective caesarian" and that this should have "implications for reducing perinatal transmission of blood-borne viruses" (248).

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.