Women and HIV Infection

DATRI coordinators plan to begin a pilot study of the effect of treatment on viral shedding in
cervical secretions compared to amount of virus in the blood, immunological markers and clinical
status of women with HIV infection. The study also assesses gynecologic risk factors associated with
viral shedding in vaginal and cervical fluid.
Perinatal Transmission
NIAID-supported studies have shown that, in the United States, HIV is transmitted from mothers
to infants about 24 percent of the time. Researchers base their findings on blood samples taken from
babies through six months of age. Other studies have documented rates of transmission ranging from
13 to 40 percent. Rates in developing nations are higher.
How perinatal transmission occurs is still unclear. Studies indicate that infection can occur
during pregnancy, during birth and postpartum. In a large European study, breast feeding was
associated with a 14 percent increase in the risk of transmission. In developing countries, the World
Health Organization recommends that HIV-infected women continue to breast-feed because the benefits
outweigh the risks of transmission to their children. Breast feeding is discouraged in the United States
for women with HIV infection.
Other questions regarding women who have HIV and are pregnant, include the effect of antiHIV drugs on both the mother and the fetus, the influence of HIV on pregnancy and the effects of
pregnancy on the course of HIV infection. Researchers are hopeful that current NIAID studies such
as the Women and Infants Transmission Study (WITS) will answer many of these questions.
NIAID established WITS in conjunction with the National Institute of Child Health and Human
Development in September 1989. The study addresses specific questions relating to the natural history
of HIV in pregnant and nonpregnant women, including gynecologic complications of HIV disease,
changes in the immune system during infection and progression of disease. WITS has successfully
recruited a multi-ethnic population of women with HIV from the mainland United States and Puerto
Rico. A large number of social, demographic and behavioral risk factors among these women make
it difficult to assess HIV-specific effects on pregnancy.
Investigators at the University of Medicine and Dentistry of New Jersey, funded by NIAID and
the Walter Reed Army Institute of Research in Washington, D.C., are conducting a separate
maternallinfant study. This study compares the natural history of the pregnancies of women with HIV
compared to women who do not have HIV, and examines any effects of illegal drug use on their
pregnancies. This study is coordinated with a CDC-sponsored perinatal study at the same site.
Vaccines and Pregnancy
As more women of childbearing age become infected with HIV, experts expect a concurrent rise
in the number of infected children. Under NIAID sponsorship, early clinical trials of two experimental
AID)S vaccines are under way. Investigators are hopeful that the vaccines will reduce the amount of
virus present in the pregnant women and improve their health, while simultaneously stimulating
antibodies that will prevent their passing HIV infection to their babies. Another candidate vaccine is
scheduled to be tested in pregnant women later this summer.