Pregnancy appears to cut risks for HIV-infected women

Women with HIV infection who become pregnant have a lower risk of progression to AIDS and death, researchers at Vanderbilt University Medical Center report.

Their findings, posted last week on the online edition of the Journal of Infectious Diseases, suggest that “the complex set of immunologic changes” that occur during pregnancy may be interacting in a beneficial way with combination drug therapy.

Some previous studies in the developing world had reported higher levels of complications and deaths from AIDS among pregnant women. But those studies were conducted before the advent of highly active anti-retroviral therapy (HAART), drug “cocktails” that over the past decade have dramatically reduced death and complication rates among people infected with the AIDS-causing human immunodeficiency virus (HIV).

The Vanderbilt study included 759 women treated between 1997 and 2004 at Nashville's Comprehensive Care Center, one of the nation's largest outpatient AIDS treatment programs. More than 500 of these women received HAART, including 119 of the 139 women who had at least one pregnancy during the study period.

After using statistical modeling methods to adjust for differences between women, including their age, health and response to therapy, the researchers found that “pregnant women did better,” said Timothy Sterling, M.D., the study's senior author and associate professor of Medicine.

In addition, women who became pregnant more than once during the study tended to have a lower risk of disease progression than did women who became pregnant only once. That also supports the conclusion that something about pregnancy is beneficial, he added.

However, more study is needed, Sterling cautioned. Pregnant women were healthier than the women who did not become pregnant, and they may have been more likely to adhere to their therapy out of concern for the fetus.

They also received “intensive care” — frequent visits with their physician, case managers and nutritional counselors. “Perhaps efforts should be made to do that for everyone, pregnant or not, female or male,” he said.

The study was begun four years ago by first-year medical student Mercy Udoji as part of what is now Vanderbilt Medical School's Emphasis Program, which provides a variety of research and scholarly activities for students during their pre-clinical years.

Jennifer Tai, M.D., made major contributions to the study while participating in the Vanderbilt Medical Scholars Program.

Tai, currently a resident in pediatrics at the University of Colorado, and Udoji, a resident in anesthesiology at Duke, are listed as first authors on the paper and previously have presented data from the study at scientific conferences.

“They both did a fantastic job,” said Sterling, who directs the Epidemiology/Outcomes Unit of the Vanderbilt-Meharry Center for AIDS Research. “Neither one had formal training in statistical methods or analysis, but they learned the necessary skills through the conduct of this study.”

“Seeing this project from start to finish has made me recognize the rising importance of clinical research and its role in patient care,” said Udoji, a Nashville native and former Tennessee State University track star. “I look forward to participating in more projects in the future.”

The study was supported by the National Institutes of Health. Co-authors were Gema Barkanic, Daniel Byrne, Peter Rebeiro, Beverly Byram, Asghar Kheshti, Justine Carter, Cornelia Graves, M.D., and Stephen Raffanti, M.D.