Therapy for HIV in Pregnant Women
May Not Harm Baby
Pregnant women who are HIV positive often face a "Catch-22" situation. Antiretroviral therapy is effective in preventing viral transmission to the fetus, as well as helping to suppress the HIV virus in the woman. But these are powerful drugs with a high potential for adverse reactions, and information about their effect on a growing fetus is limited. Guidelines from the National Institutes of Health recommend that an HIV-positive woman receive appropriate antiretroviral therapy whether or not she is pregnant, and new research, reported in the November 1999 issue of Obstetrics & Gynecology, suggests that the drugs may be safer that previously suspected.
Researchers from Albert Einstein College of Medicine and two New York City medical centers observed that pregnant women who received combination antiretroviral therapy sustained a decreased viral load and prevented HIV transmission to their newborn babies, and the drugs did not appear to be highly toxic to infants. Of the 28 infants born to study participants, one was stillborn and two were preterm. Aside from one born with microcephaly, none of the babies had major birth defects, and no gross abnormalities were noted in the stillborn infant.
Maternal complications included one case of exacerbated hepatitis C, one case of gestational diabetes, and four cases of pregnancy induced hypertension. Over half of the women already had AIDS, two-thirds had previously used antiretroviral therapy, and 37 percent had a history of illicit substance abuse.
The researchers acknowledge that the results conflict with a recent study that reported adverse effects in infants exposed to combination antiretroviral therapy. They write that their findings are encouraging but not conclusive and do not evaluate the long-term effects of exposure. Larger controlled studies are needed, as well as reports of long-term follow-ups of antiretroviral-exposed infants, say the researchers.
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