United Press International; Wednesday November 26, 1997 - 10:01 PM EST
Lidia Wasowicz, UPI Science Writer

In fact, since April 1995 none of the 56 HIV-positive women in a special University of California, San Francisco, program using that formula has given birth to an infected baby.

Dr. Karen Beckerman, director of the program at the Bay Area Perinatal AIDS Center at San Francisco General Hospital, says, "Our ultimate goal used to be to prevent transmission from mother to child. Now it's to get the mom to her child's high school graduation."

The program, established in 1989, provides coordinated care and services for pregnant women infected with the human immunodeficiency virus, HIV, which causes acquired immune deficiency syndrome, AIDS.

Beckerman tells UPI, "In the past two to three years, we've gone through a revolution in the way we care for people with HIV infection so that now we are able to treat HIV as a chronic disease, which we attempt to keep under control. Our goal has expanded from just preventing transmission _ though that's important _ to getting the mom to her baby's graduation."

By tailoring treatment to the woman's individual needs, the doctors have found dramatic decreases in the infection rates among the babies. None of the 58 babies born to the infected mothers in the program have tested positive for HIV.

Beckerman attributes some of the success to combined antiretroviral therapies. The UCSF researchers took part in national clinical tests that found use of the drug AZT during pregnancy and delivery significantly reduced rates of perinatal HIV transmission. Since then, studies have shown even better results with a combination of drugs.

Since June 1996, most of the patients in the program have been given combination therapy rather than just AZT alone.

Beckerman says, "It's more than just the drug combo that's at work here, however. Not every mom gets the triple therapy; some get two drugs, and a very few get just one (AZT)."

She adds, "What we try to focus on is the idea that women who come to BAPAC will get lots of education and counseling and state-of-the-art therapy but no agenda will be forced upon them. That's an important part of our program, the self-empowerment of our clients, who re-establish or maintain control over their lives."

Another key ingredient is the easy access at San Francisco General to viral burden measurements, which are telling in the activity of the disease and whether therapies are working.

Beckerman says, "That's been extremely important beause if a therapy is failing, we can either switch to something else or find out what's wrong. Is the mom throwing up too much or not taking the drugs as she should? Then we can take measures to correct the problem."

This trend is spreading across the country, she says, with successful results.

Says Beckerman, "We've had a 5 percent mom to baby transmission rate with women getting AZT alone, and some other centers are seeing even lower rates in such cases."

While she is elated at this success, Beckerman says, "I do wonder when the next infected baby will be born, and I am very concerned about the mother's health. I really want these babies to have moms when they grow up."

She says a major challenge is the mom's ability to continue the demanding treatment regimen. Some of the women have already suffered increases in their HIV viral loads because they stopped adhereing to the strict requirements, and the problem of drug resistance is beginning to emerge.

Says Beckerman, "It appears to be a significant challenge to stay on the drugs and take care of a newborn. It's still very early, and we don't know what will happen."

She hopes the program's counseling, support, careful monitoring and ongoing expert care continue to make a difference.

Beckerman will present the report Monday, World AIDS Day, at the inauguration of the UCSF AIDS Research Institute, the largest AIDS initiative outside of the National Institutes of Health.

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