United Press International - Wednesday, 15 August 2001
Ed Susman, UPI Science News

In a report to the National HIV Prevention Conference in Atlanta this week, doctors said that the women were either unable to adhere to the complicated multi-drug regimen or were unwilling to comply with the program on their own.

"We offered them the opportunity to receive the medication in the hospital, and the women -- who said they were doing it for the health of their unborn children -- checked themselves in," Dr. Patricia Garcia, assistant professor of obstetrics and gynecology at Northwestern University, told United Press International.

Garcia and colleagues expected that "directly observed therapy" -- drugs administered by hospital staff -- would lower the amount of circulating human immunodeficiency virus (HIV) and that might translate in lower risk of transmitting the virus to the child.

The result: in all three women the treatment was able to substantially reduce viral load and all three babies were HIV-negative.

"Those children are nine months old now," said Garcia, who is also a researcher with Pediatric AIDS Chicago. "All the babies remain healthy. We were able to take on this project because obstetric departments are used to having at-risk mothers in the hospital for several weeks."

The three women were hospitalized at Northwestern Memorial Hospital in Chicago, for 36 days, 42 days and 72 days respectively before delivering their babies.

"We offered them the option of directly observed therapy when it became apparent that the women were unable or unwilling to adhere to highly active antiretroviral therapy (HAART) on their own," said Anne Statton, a project director for the Garrick Foundation-funded Prevention Initiative of Pediatric AIDS Chicago. The women were part of a larger study under the auspices of Pediatric AIDS Chicago.

"We asked the women only to keep their rooms clean," Garcia said. "It costs about $1,000 a day per patient to keep the women in the rooms, but it is estimated that the cost of caring for one HIV-infected baby is about $350,000 during that child's life." She estimated that the cost of having the three women stay is the hospital was about $140,000. Statistically, Garcia said, it is likely that the intervention prevented at least one of the children from being born with HIV-infection, so in societal terms, the treatment procedure was cost-saving.

"Hospital-based, directly observed therapy is an acceptable intervention," Garcia said, "capable of assuring a reduction in maternal viral load and thereby substantially reducing the risk of pediatric HIV disease."

"While hospitalization is one method of directly observed therapy," said Dr. Helene Gayle, director of the National Center for HIV, STD and TB Prevention for the Centers for Disease Control and Prevention, Atlanta, "it is an expensive option." She said that alternative approaches might follow the format of outreach programs that involve directly observed treatment for tuberculosis patients.

However, in some cases, the personal circumstances of the patient, might make in-hospital treatment necessary. Gayle agreed that without treatment there was a risk that one of the babies would have been born with the disease.

In the natural history of the disease, about 30 to 40 percent of HIV-infected mothers give birth to infected children if they receive no antiretroviral treatment. But in the United States that risk has been reduced by nearly 90 percent with aggressive HAART treatment. Gayle said that during the height of the epidemic in the United States, before the advent of potent drugs to combat HIV, 900 babies a year were born infected. Now, she said, it appears that number will be less than 100 a year.

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