WASHINGTON--Since the first case of AIDS appeared in the United States in
1981, 60,000 women have been diagnosed with the disease, 14,000 of them (25% of
the total number of women) in 1994 alone. HIV in women is increasing at the rate
of 17% a year, and one in four new cases in 1994 occurred in women under the age
At a well-attended 3-day conference on HIV infection in women, Martha Rogers,
MD, chief of the epidemiology branch in the Centers for Disease Control's
HIV/AIDS Prevention Division, announced the agency's new draft guidelines about
HIV testing and treatment in pregnant women.
The guidelines (see table ) stem from a study
done by the National Institute of Allergy and Infectious Diseases (NIAID) AIDS
Clinical Trials Group that showed a clear advantage to women who had received
AZT (zidovudine, Retrovir) during their pregnancy, as well as to neonates who
received the drug for the first 6 weeks of life.
The controlled double-blind study, completed in early 1994, showed that the
women who received AZT had an 8% vertical transmission rate, compared with 25%
for the control group. Now that AZT has been shown to be beneficial during
pregnancy, the FDA has changed the drug's labeling to allow its use during
gestation and labor.
The meeting was not without controversy, as AIDS activists also were heard.
Maxine Wolfe, from ACT-UP in New York, described the federal delays in
recognizing the incidence and prevalence of HIV infection in women as "criminal
Kathy Anastos, MD, director of Ambulatory Services at Bronx-Lebanon Hospital
in New York, noted that women were not generally used as clinical research
subjects when she entered medicine in the 1980s. "Early in the epidemic, there
was almost no research on AIDS in women, and what there is treats them as
vectors for the disease in men--not as victims themselves," she said.
Patricia Fleming, director of the Health and Human Services (HHS) Office of
National AIDS Policy, said that women's HIV symptoms traditionally have been
ignored "because everyone thought they didn't get AIDS." She added that women
had been given short shrift in clinical research until the NIH instituted a
regulation that requires women and minority representation in all clinical
"NIH now has a task force on women's issues," Ms. Fleming said, and it is
sponsoring an interagency study on the natural history of HIV infection in
women. Moreover, "NIH is committed to the development of female control barriers
such as a vaginal microbicide."
HHS encourages all pregnant women to submit to voluntary HIV testing (about
90% accept), a policy endorsed by the American College of Physicians, the
American College of Obstetricians and Gynecologists, and other medical groups.
The federal government, Ms. Fleming said, does not recommend mandatory testing
of pregnant women because it believes that such a policy might cause women to
avoid testing by eschewing all prenatal care.
About 4 million women become pregnant each year in the United States;
therefore, the $25 per HIV test represents a major health-care investment.
Approximately 7,000 HIV-positive women give birth each year, according to the
CDC, and about 2,000 babies are born HIV positive. However, the CDC maintains
that the cost of HIV testing will pay for itself if the number of HIV-infected
babies can be significantly reduced.