Although the US has seen a significant decrease in the number of HIV-infected newborns, there remains a group of vulnerable children who may be infected with HIV because neither they nor their mothers were tested.

In a recommendation released Monday, the US Preventive Services Task Force says that the current strategy of offering tests only to "high risk" women is missing many opportunities to save babies. About 300 infants are born infected in the United States each year -- and as many as 40 percent, or 120, are born to mothers who did not know they had HIV infection before delivery.

"We should offer the test to all pregnant women -- and allow them the chance to say yes or no," said Dr. Diana Petitti, vice chair of the task force.

Very Few Risks

If more maternal infections are detected early, steps can be taken to help prevent transmission to newborns, the panel concluded. Its recommendation was published in the Annals of Internal Medicine.

"An HIV test is looked at, more and more, just like any other test that one would recommend at a time of prenatal care, with very few risks and many benefits," said Petitti.

The US Centers for Disease Control reported in June that the highest rate of infection in the country occurs among bisexual black men. And because men are reluctant to disclose gay sex to their female partners, this has implications for unprotected women -- and their children. Black women are 19 times more likely to be infected than white women.

"The reality is that people don't know everything about everyone's vice, even when they are very intimate," said Petitti. "There are lots of surprises."

"It is better to know than not to know. You can't solve a problem you don't know about."

Risk Can Be Reduced

In pregnant women, early identification of HIV infection allows treatment to prevent the spread of infection. Without treatment, the chance of a baby becoming infected is one in four. This risk can be reduced to less than one in 20 if women stay healthy, participate in prenatal care, take anti-AIDS medications and bottle-feed instead of breast-feed. At-risk babies also get medication after birth to fend off infection.

Additionally, HIV tests no longer carry the stigma they once did and may be less frightening to women, according to Petitti. "HIV has evolved into a more chronic manageable illness, rather than a death sentence it seemed to be in the `80s and `90s, because of the availability of therapy," she noted.

The physician panel recommends only voluntary, not mandatory, testing. Some nations, such as Ireland and Australia, are considering mandatory testing.

And although the doctors' advice is not binding, it is likely to influence medical policy. It echoes earlier recommendations by the federal Centers For Disease Control and the American College of Obstetricians and Gynecologists -- creating now-widespread consensus in the field.

It could also change the perception of the HIV test in the public's mind, she said.

"Maybe the test will become less controversial and more routine," said Petitti, who is also a Scientific Advisor for Health Policy and Medicine for Kaiser Permanente-Southern California in Pasadena.

Vulnerable Children

In reviewing its previous position, the task force considered growing evidence that intervention can save babies.

"I think it's pretty amazing -- and really one of the miracles of medicine -- that the risk of transmission now can be reduced to well below 5 percent," she said.

When the Bay Area Perinatal AIDS Center at the University of California-San Francisco opened at the height of the epidemic, there wasn't much anyone could do. With few good drugs to reduce risk, children were often born infected and died young.

But through the 1990s, the number of babies born HIV-positive began to decline. Children started to live longer. Many are living to their teenage years and beyond.

The last case of maternally transmitted HIV transmission at the center was in 1999. In that case, the mother had refused HIV testing during pregnancy and only discovered her HIV status several months after delivery when her baby became ill.

So few American babies are born infected with HIV these days that health officials are daring to speak of eliminating the AIDS-causing virus in newborns altogether.

Although the nation has seen a significant decrease in the number of HIV-infected newborns, there remains a group of vulnerable children who may be infected with HIV because neither they nor their mothers were tested.

These are the children the Task Force hopes to save.