THE VIRGINIAN-PILOT
Copyright (c) 1997, Landmark Communications, Inc.
DATE: Tuesday, January 21, 1997 TAG: 9701210419
SECTION: FRONT PAGE: A1 EDITION: FINAL
SOURCE: BY DEBRA GORDON, STAFF WRITER
LENGTH: 111 lines
The framed picture on the wall of the small Chesapeake ranch house shows a blond-haired toddler, dressed in velvet and lace, perched before a Christmas tree.
It shows a healthy little girl.
The 2-year-old represents one of the few success stories in the 15-year fight against AIDS: the dramatic reduction in the transmission of HIV, the virus that causes AIDS, from infected women to their newborns. Nationally, rates have dropped about two-thirds, from 23 percent to 7 percent.
But earlier this month, a widely publicized National Cancer Institute study showed that the only anti-HIV drug licensed for use by pregnant women - AZT - causes cancer in mice exposed to high doses in utero. Because mice metabolize drugs in a manner similar to humans, the study raises the possibility that women who take AZT during pregnancy may bear children who are at a higher risk of developing cancer.
``It doesn't concern me,'' said the little girl's 24-year-old mother, Renee, who was diagnosed with HIV five years ago and asked that her last name not be used. ``It's really up to the Lord.''
The study has been attacked by several national experts, who say the nearly toxic doses of AZT the mice received are three to seven times the lifetime dose given pregnant women.
Tidewater Regional AIDS Center Director Dr. Bonnie Datel, who treats most of the pregnant, HIV-infected women in Hampton Roads, not only questioned the study's validity - ``frankly, there's very few things that, if given in high enough doses, won't induce cancer'' - but fears it may frighten women away from using AZT during pregnancy.
And that would be a mistake, she says.
At Eastern Virginia Medical School, where Datel is associate director for the maternal/fetal medicine division, she and her team have used AZT to dramatically reduce HIV transmission from pregnant women to their babies. Without the drug, 31 percent pass on the virus; with it, only 14 percent. Datel treats about 50 to 60 HIV-infected women each year.
To jeopardize such success because of how a mouse's immune system reacts to near-toxic doses of the drug makes Datel angry.
``I don't think this should be cause for alarm, or that women should not be offered AZT,'' she said. ``For my take on it, AZT has more benefit than potential harm at this point.''
Datel's viewpoint is shared by others in the field. A panel convened by the National Institute of Allergy and Infectious Diseases last week unanimously recommended no change in treatment guidelines for AZT. The panel stressed that whatever potential harm the drug might have paled when compared with the benefit of preventing HIV infection. Other animal studies, the panel said, show that AZT does not cause cancer.
Women take AZT in pill form during pregnancy, receiving an intravenous version during labor and delivery. Then the newborn gets the drug for several weeks. AZT, or zidovudine, works by inserting itself into the virus' DNA, interfering with its ability to replicate.
Renee, who learned she had HIV when she was pregnant with her son, now 5, refused to take AZT during that first pregnancy. Then, the drug was still being tested in pregnant woman.
But when she became pregnant with her daughter, she was already taking AZT. After the baby was born, she had to give the infant a dropper of the clear liquid form of the drug every six hours.
Giving her daughter the same medication she herself was taking, Renee said, brought home the reality of the disease like nothing else could.
But Renee was lucky. Neither of her children have the virus.
Ninety percent of the nation's 7,472 reported pediatric AIDS cases occurred through maternal transmission, according to the Centers for Disease Control and Prevention. Before the AZT program began, 6,000 to 7,000 children were born annually to HIV-infected women; an estimated 1,000 to 2,000 of them became infected each year, peaking in 1992.
But by 1995, the latest year for which data is available, only 663 new cases were reported, and the CDC claims the new standard of care with AZT is the reason.
Even as Datel urges her HIV-infected patients to use AZT, she is asking them to participate in another study, one that may reduce HIV transmission rates even more.
The national study, conducted through the National Institutes of Health, began in December. Pregnant women receive IgG-class antibodies - a manufactured protein - intravenously every month beginning in their fourth month.
Antibodies are proteins in the blood created when a person is exposed to a virus, which provides immunity against future exposure to that virus.
IgG-class antibodies are the only type that cross the placenta and enter the baby's bloodstream. Thus, Datel said, researchers theorize that they could protect the baby when it is at greatest risk of getting the virus - during birth.
Three women are enrolled in the EVMS study, Datel said. She hopes to enroll all HIV-infected pregnant women who meet study criteria. Women still receive AZT while on the antibody study, and the therapy is not intended to replace AZT therapy. ILLUSTRATION: Color photo
BETH BERGMAN/The Virginian-Pilot
Dr. Bonnie Datel urges HIV-infected pregnant patients to use AZT -
the treatment, she and other doctors have found, dramatically lowers
the chances of transmitting the virus during childbirth.
Graphic
HIV STUDY GUIDELINES
To participate in Eastern Virginia Medical School's study of the
use of IGG-antibody in pregnant women infected with HIV, women must:
Have a CD4 cell count - a measure of the strength of the immune
system - between 200 and 500.
Be available for monthly IV infusions. The infusions take several
hours, and women are monitored during the procedure.
Ideally, be in early stages of pregnancy, although women can
enroll up to their third trimester.
For more information, contact the Women's Health Center at
Eastern Virginia Medical School at 446-7913.
KEYWORDS: TREATMENTS AIDS HIV