BESIDES the advent of medications to prolong the survival of those living with HIV, one of the success stories in the management of HIV is that we could now reduce the risk of transmission from mother to child from 25% to 30% to about 2% to 4%.

Contrary to popular belief that all mothers who have HIV will transmit the virus to their children, only about one in four babies born to mothers who are HIV-positive will get the virus if nothing is done, said paediatric infectious diseases consultant Dr Kamarul Razali.

Transmission of the HIV from mother to child can occur any time during pregnancy, but usually happens just before or during delivery. It can also happen when a mother who is HIV-positive breastfeeds her child.

"Now, if we can give medications to the mother during pregnancy or during labour; or prophylaxis to the baby after he or she is delivered, the risk of transmission can be reduced to about 2% in developed countries.

"However, in Malaysia, the risk can be reduced to about 4%," he said.

According to Dr Kamarul, some of the reasons Malaysia has a higher percentage of mother-to-child transmission include mothers who come late, mothers who do not go for antenatal testing and mothers who got pregnant when they already have advanced disease.

Some mothers come late, even only during labour. But even in the labour suite we can do a rapid screening test and give medications to the mother during labour, or to the baby just after delivery, to help prevent the baby from getting the virus, Dr Kamarul said.

As for mothers who already have advanced disease, where they already have AIDS, about 9% of the babies are already infected in the first trimester of pregnancy. And if a mother who has HIV breastfeeds, she could transmit the virus to the child too, he said.

"In Malaysia, we do not allow mothers who are HIV-positive to breastfeed," Dr Kamarul said. "The risk of transmission through breast milk is high."

Currently, HIV testing is done for all expecting mothers in an opt-out system available in all government hospitals. Mothers who are found to have HIV are given counselling and appropriate treatment to prevent their babies from getting HIV from them.

However, "short-course" treatments to prevent infection of a newborn only during labour and delivery may cause resistance of the HIV in the mother and reduce further treatment options for her. Women who are already on treatment may have to stop their medications as some of them may cause birth defects if taken during the first few weeks of conception.

That is why, while steps can be taken to prevent a child from getting HIV from his or her mother, women who are living with HIV should discuss their wishes with their doctors to make an informed decision. Women who are found positive during antenatal testing can, however, carry on with their pregnancy as there are treatments available to prevent mother-to-child transmission of HIV.