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News Briefs

September/October 2001


Cesarean Complications

A comparison of 86 HIV-positive women and 86 HIV-negative women undergoing cesareans showed that positive women had more minor complications, such as fevers, following surgery than negative women. However, women with HIV viral loads between 1,000 to 10,000 were eight times more likely to experience complications than were women with undetectable viral loads.

In reporting these new findings in the American Journal of Obstetrics and Gynecology, Dr. Elisa Josefina Rodriguez and colleagues note that caution is still needed in making a decision to deliver by cesarean in positive women when not medically necessary. Elective cesareans are shown to decrease the risk of transmission, but not any greater than the use of potent HIV medications which significantly decrease a mother's viral load. Of course, HIV infection for a child is in itself a major complication that should be considered in making a decision.

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HIV Drugs in Pregnancy: Updated Guidelines

The following is taken with permission from a recent newsletter of WORLD (Women Organized to Resist Life-threatening Diseases) in Oakland, CA.

On May 4, 2001 a Public Health Service Task Force published updated guidelines on how HIV drugs should be used in pregnant women with HIV. Other aspects of health care for HIV-positive pregnant women -- such as preconception (before pregnancy) counseling, C-section, and monitoring tests -- are also discussed. Here are some of the things in the guidelines and information about how to get them:

  • Treat (give drugs to) all pregnant women . . . to reduce the risk of passing HIV to the baby.

  • HIV-positive pregnant women should avoid or be extra cautious about certain drugs or drug combinations. These include: ddI + d4T (in combination) [Videx and Zerit]; the oral solution of amprenavir [Agenerase] (capsule form is okay); hydroxyurea and efavirenz [Sustiva] should be strictly avoided during pregnancy; and AZT + d4T [Retrovir and Zerit] should not be used together in any HIV patient, not just the pregnant ones.

  • C-sections, done at 38 weeks gestation, should be considered for women with viral loads over 1,000 at 36 weeks. For women with viral counts under 1,000 it is unlikely that C-section would provide any added protection, though there's not enough information to be sure yet. Providers should get the mother's full informed consent before doing a C-section, because a C-section is major surgery and poses risks to the mother's health. [Editor's Note: A substantial review of elective -- emphasis on elective -- C-sections in positive women found few major complications. -- EV]

For more information,

  • You can obtain the full text of the new perinatal guidelines at http://www.hivatis.org or by calling the HIV/AIDS Treatment Information Service (ATIS) at 1-800-448-0440.

  • You can also get the most recently published report from the Antiretroviral Pregnancy Registry (or have your doc report complications to them, especially if you suspect your child has problems related to your taking HIV drugs during pregnancy) from: The Antiretroviral Pregnancy Registry, Research Park, 1011 Ashes Drive, Wilmington, NC 28405. Call 1-800-258-4263 (free for US and Canada), international telephone 1-910-256-0238. Fax 1-800-800-1052, international 1-910-256-0637 or +44 1895 825 005.


Lactic Acid and Liver Problems

Prominent HIV specialist Dr. Andrew Carr of Australia and colleagues warned that people with HIV may suffer liver damage without the usual symptoms. They wrote a case study in The Lancet medical journal in May about a positive man who had taken Retrovir (AZT, zidovudine) by itself in the early '90s, stopped for three years, then took a combination of Zerit (d4T, stavudine) and Videx (ddI, didanosine). About a year after that he had weight loss, fatigue, nausea, a distended stomach and difficulty breathing. Lab work indicated that he had hepatitis (liver disease) and lactic acidemia, both of which reversed after stopping meds. Later, however, even though he had only slightly elevated liver function tests and lactate levels were normal in his blood, the lactate level in his urine was high. He soon died of internal bleeding. The doctors noted that low-level lactic acidemia may be the cause of ongoing liver damage that could be hard to detect. They noted that the class of HIV drugs called nucleoside analogues, from which all three of the drugs noted are taken, are associated with lactic acidemia and mitochrondial toxicity, as found in this patient.


More Lactic Acid, with Bone Problems

Dr. Carr and two of his colleagues also made a separate report linking lactic acid to osteopenia. They reported that osteopenia (reduction of bone tissue to below normal levels, which can weaken them and eventually lead to fractures) is common in HIV-positive men, but that men tend not to show symptoms of the condition. The osteopenia was also associated with lower weight prior to HIV therapy and with lactic acidemia due to treatment with nucleoside analogs. The findings were published in the April 13th issue of AIDS.


Hep C

The Food and Drug Administration (FDA) has approved an "unbundled" version of Rebetron. The combination hepatitis C treatment consists of Intron-A (interferon alfa-2b) and Rebetol capsules (ribavirin), both made by Schering-Plough. Rebetol capsules will now be available by themselves. The Hepatitis C Action and Advocacy Coalition (HAAC) contends that the capsules will be priced so high that doctors will be discouraged from combining them with interferons from other companies. These combinations may be more effective for some patients. Compounded ribavirin is still available at a lower price. Contact HAAC at HAAC_SF@hotmail.com.


UN Session on AIDS

The United Nations in June held a special session on HIV/AIDS. An exhaustive list of priorities were presented, among them the need for prevention efforts for young people, ensuring rights for people living with the virus and stronger commitments for fighting HIV -- including treatment -- from all governments. For transcripts, video search, and complete archived webcast from the special session, visit http://www.kaisernetwork.org/healthcast/un/aids/jun01.


HIV Drugs and Insulin Resistance

An association has been seen between HIV therapy and insulin resistance, a condition whereby the body is unable to adequately use its supply of insulin. This hormone helps regulate sugar in the body. Insulin resistance is in turn associated with all kinds of problems, including diabetes and heart disease. Doctors giving the HIV protease inhibitor Crixivan (indinavir) to 10 healthy people without HIV observed that they developed insulin resistance after four weeks on therapy. The men took 800mg of Crixivan twice a day. Dr. Mustafa A. Noor and colleagues reported their results in AIDS. They noted that genetic factors need to be examined and, of course, the other HIV drugs should be examined for this effect. The reason why insulin resistance is being seen is still unknown.


Circuit Party Transmission

Circuit parties are large-scale, razzle-dazzle dance parties and party marathons for gay men, held around the country to raise money for HIV-service organizations. The parties have drawn strong criticism for high incidence of sex and drug use that potentially contribute to HIV transmission. However, defenders say that transmission can occur anywhere, not just at circuit parties. Kudos to researchers writing in the American Journal of Public Health for reminding people that unprotected anal sex may lead to transmission owing to "a lack of knowledge about -- or incorrect disclosure of -- current HIV status." Gordon Mansergh and colleagues surveyed 295 men to document the sexual activity and drug use of the circuit.


Methadone Cuts Mortality

In the May issue of the American Journal of Public Health, other researchers reported that injection drug users who drop out of a methadone program are more than four times likely to die of an overdose. They looked at 827 participants of the Amsterdam Cohort Study. The researchers stated that "harm reduction-based methadone treatment, in which the use of illicit drugs is tolerated, is strongly related to decreased mortality from natural causes and from overdose. Provision of methadone in itself, together with social-medical care, appears more important than the actual methadone dosage." They also noted that while HIV has increased deaths among injection drug users, overdose remains a more common cause of death for IDUs in most countries.


Gay and Lesbian Healthcare Not Up to Snuff

An online survey of lesbians and gay men taken by GayHealth.com found that 40% of the men had not been vaccinated against hepatitis A and B. The potentially fatal infections are spread through sexual contact and are more common among men who have sex with men than among other groups. GayHealth.com associate medical director Susan Ball said, "Every gay and bisexual man should be vaccinated against hepatitis A and B. They are serious conditions, especially for patients co-infected with HIV." As for the women, almost 18% report having never visited a gynecologist and 23% report having not seen one in more than two years. The report noted that yearly Pap smears are the best defense against cervical cancer. The majority of cervical cancer cases are caused by the human papilloma virus (HPV), which can be transmitted by woman-to-woman contact.


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This article was provided by Positively Aware. It is a part of the publication Positively Aware. Visit Positively Aware's website to find out more about the publication.
 
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