Most people who participate in medical studies hope that the research findings will help others. The 2,628 women who enrolled in the Women's Interagency HIV Study (WIHS) since it began in 1994 have contributed a lot of time and energy over the years. The following is a brief summary of some of the important findings that have come out of this study, thanks to the dedication of its participants and researchers.
In late 1995, highly active antiretroviral therapy (HAART) was introduced. The number of women on HAART increased after April 1996, and WIHS research clearly shows a decline in HIV-related death, a decline in the progression of HIV to AIDS, an increase or no change in CD4 cells, and a decline in HIV (viral load) in the blood. (Higher CD4 cells and lower viral load levels are signs of an improved immune system.)
WIHS research shows that CD4 cell levels of less than 200 continue to be a strong predictor of AIDS and death. Early data from one study show that there appears to be no benefit from starting HAART therapy in symptom-free individuals with CD4 cells greater than 350, but longer follow-up is needed. Research also shows that women on HAART are less likely to have visited the emergency room or had a hospital admission.
The above findings illustrate the need for educating HIV-positive people about the possible benefits of starting HAART at the appropriate time, and the value of regular health care visits to the doctor.
WIHS investigators have found that HIV-positive African American women and women reporting a history of injection drug use, or recent drug or alcohol use, were less likely to report HAART use. This demonstrates the need for strong outreach to women in vulnerable populations.
WIHS research has also shown that adherence (taking medications exactly as prescribed) to a HAART regimen has sometimes been difficult. Reported reasons for non-adherence are forgetting to take medications and unpleasant side effects. One WIHS study showed that one-third of women on HAART reported some "switch" in their regimen. Frequent switching of medications can lead to decreased effectiveness, increased risk of some side effects and reactions, and fast development of resistance to HIV medication. This demonstrates the need to educate people about the importance of adherence and provide them with tips on remembering to take medications and dealing with side effects.
By testing samples sent in from the clinical sites, WIHS researchers discovered that a large number of the HIV-positive women in the study are also infected with the human papilloma virus (HPV), the virus that can cause genital warts and put women at increased risk for cervical abnormalities (cervical lesions). These cervical lesions are treatable, but if left untreated they can progress in time to cervical cancer. These findings regarding HPV and cervical lesions support the need for regular Pap tests, prompt treatment of lesions when needed, intense follow-up, and education for all women about behavior changes that will reduce their risk of exposure to HPV.
Hepatitis C (HCV) is a virus that can seriously damage the liver. WIHS research has shown that women in the study who inject IV drugs or have sex with a male injection drug user are at increased risk of being co-infected with HCV. Future WIHS research plans to focus on the long-term consequences of women infected with both viruses.
Recently, the WIHS was granted funds to expand the study size. In October 2001, clinical sites around the country began recruiting 1,078 new women to join the study. This allows researchers to continue their investigations and address new issues. For more information, visit the WIHS Web site at https://statepiaps.jhsph.edu/wihs/.
Maryellen Hughes, C.N.M. (certified nurse-midwife), is a clinician at the Women's Interagency HIV Study (WIHS) at Downstate Medical Center in Brooklyn. Reprinted courtesy of www.PositiveWords.com ©2001 by Dallabrida & Associates.