Eradication of perinatal HIV may be within reach. (Vertical Transmission Rate is Less than 1%).

Twenty years into the AIDS epidemic, obstetrics boasts the brightest victory in battling the virus.

Vertical transmission rates in the United States dropped 10-fold after introduction of highly active antiretroviral therapies in the mid-1990s. With proper maternal treatment and perinatal prophylaxis, an HIV-positive woman's chance of infecting her newborn is less than 1%, compared with 28% in women with no treatment.

That's less than the overall 3% risk for having a child with a major birth defect. It's such a small risk that more and more HIV-positive women--now living with the virus as a chronic disease thanks to better treatments--are opting to have children, said Dr. William M. Gilbert, director of maternal-fetal medicine at the University of California, Davis.

Indeed, some physicians now are willing to do donor inseminations from HIV-positive male partners.

Few U.S. obstetricians see patients with HIM and those who do usually refer the women to multispecialty groups of HIV experts. After two decades, however, the disease has drastically altered medical practice as a whole. (See related story.)

For obstetricians especially, the AIDS epidemic drove home the importance of universal precautions, Dr. Gilbert said.

The risk of HIV contamination in blood products changed his approach to postpartum anemia. Before the era of HIM if a woman was a little anemic after delivery with a hematocrit of perhaps 25%, Dr. Gilbert might have given her a unit or two of blood. "Sometimes now down to a hematocrit of 20% or 15% we don't give blood" after delivery to avoid the risk of blood contaminants such as HIV, hepatitis C, or others, he said.