HOUSTON — Pregnant women should be treated for human immunodeficiency virus infections even if they are asymptomatic and have normal CD4 counts and low viral loads, said Hunter A. Hammill, M.D.
Pregnancy itself does not affect the course of the disease. The woman's condition will not become worse, but the baby is at risk, he said at a conference on vulvovaginal diseases sponsored by Baylor College of Medicine.
“Optimum therapy should be offered to minimize vertical transmission to the infant,” said Dr. Hammill of the college.
Infants of HIV-positive mothers will test positive for 6–8 weeks after birth. Without treatment, about one-third will be infected and remain positive. Breast-feeding can increase the vertical infection rate by 20%.
Studies summarized by Dr. Hammill have reported transmission rates of less than 1%–13% when various therapies were tested in pregnant women. “My series is now down to less than a tenth of a percent vertical transmission with vaginal delivery” when patients are treated with HAART (Highly Active Antiretroviral Therapy), he said.
Dr. Hammill urged practitioners to get up to date on new antiretroviral treatments. About 30 different treatment options are available, he said, and these are typically given in three-drug combinations.
Patients have to be monitored as some agents will have side effects. Among these, he listed unusual dreams, yellow skin, liver and renal toxicities, and nausea lasting several weeks until the patient's body adapts.
Some HAART drugs do pose special risks. He cited rash and hepatic toxicity with nevirapine (Viramune), hyperglycemia with protease inhibitors, and mitochondrial toxicity with nucleoside analogs.
His greatest concern is efavirenz (Sustiva), which is sometimes prescribed because it is considered safe in pregnancy. Because one animal study has linked it to monkey anencephaly, Dr. Hammill said he switches his patients to another drug.
“If you see an HIV patient on Sustiva, please think of birth control,” he said.
Dr. Hammill also urged physicians to provide intensive counseling about the importance of complying with treatment. “The big thing in AIDS is adherence,” he said. “If you don't take the drug, it doesn't work.”