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Odds and Ends

December 1999

Benefits of Resistance Testing During Pregnancy

The usefulness of resistance tests for HIV-positive pregnant women may outweigh their drawbacks. Resistance testing -- a way of measuring to which drugs a person's HIV is likely to be resistant -- is already recommended for pregnant women who haven't been on anti-HIV therapy. It's being proposed that all pregnant women with viral loads above 1,000 copies/ml should have resistance testing, even if they were or already are taking anti-HIV therapy at the time of pregnancy.

The current rate of drug resistance among pregnant women supports the use of resistance testing. During pregnancy, presence of drug resistance while taking anti-HIV therapy could increase the risk of transmitting HIV -- and even a drug-resistant strain -- to the newborn. Presence of drug resistance would call for the use of treatment with a different regimen to which HIV is sensitive, thereby providing more potent anti-HIV activity to the mother and helping to prevent mother-to-child HIV transmission.

The recommendation that pregnant women receive resistance testing reflects the current standard of individualized HIV care for pregnant women. It supports the need to develop the most active and effective anti-HIV treatment regimens for both mother and baby.

Determining which drugs no longer work, or do not work maximally, will help in this regard. This must include determining whether AZT, which is currently recommended as a component for all pregnant women's anti-HIV regimens, remains an effective and warranted drug option in each case.


Women in Control: An Update on Topical Microbicides

Topical microbicides are designed to kill, block and/or neutralize bacteria and virus before they enter the body or infect cells. They're currently being studied as a woman-controlled method for preventing HIV and other sexually transmitted diseases (STDs). Microbicides may be used as creams, gels, vaginal suppositories or vaginal rings. Ideally, they would be long-acting and applied hours before sex without being messy or irritating.

If these products prove effective, women living with HIV may use them two different ways. The first would be to prevent sexual transmission from or to their partners (and perhaps prevent themselves from getting other STDs). The second would be as a vaginal wash during pregnancy that may prevent passing HIV from a mother to her child. The vaginal wash could be used along with currently approved methods to further decrease the risk of mother-to-child transmission.

Currently, 23 microbicides are being studied and 50 more are being developed. Researchers hope the first microbicides will be available in the next few years.

Yes to Woman-Centered Care!

Why do many women living with HIV still have unmet medical needs? A recent study of women's medical services in five cities found several factors that result in uneven medical access for women. The most important factor was women's family obligations. In other words, many women look after their family's health before taking care of themselves.

Woman-centered care is family-centered care because focusing on women often includes focusing on family health. When asked about the type of care they need, women noted the following important points:

  • a comfortable, safe atmosphere that feels homey,

  • transportation to and from services,

  • childcare on site, and

  • help with food and housing, and getting several services in one place.
Current woman-centered services report increases in the well-being of their clients. The study concludes that woman-centered care settings should not be viewed as an impossible ideal but as the goal for which we all need to advocate.

Adherence to Therapy: Are Women Different?

Adherence to therapy means taking your drugs according to the dose and timing prescribed. Studies show there's no real difference (based on gender alone) between women and men adhering to therapy regimens.

When asked about missing doses of medication in the last three days, there was little difference between the number of women vs. men who missed a dose. The same was true for doses missed in the last day. In general, neither men nor women, as groups, showed very good adherence habits.

Women with children did not fare quite as well, however. Overall, the study showed that women with two or more children may have many more barriers to adherence than women with fewer or none.

Adherence to medication is an ongoing process. Studies show that a doctor's ability and willingness to work with a patient can impact one's ability to stay on a demanding drug schedule. It's important for women to get the help and support they need today for proper adherence tomorrow. A good plan for adherence begins with a wise choice of therapy, one with which a woman believes she can cope.

Back to the Project Inform WISE Words December 1999 contents page.

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This article was provided by Project Inform. It is a part of the publication WISE Words. Visit Project Inform's website to find out more about their activities, publications and services.
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