HIV Treatment for Pregnant Women Should Be Considered

Experts in HIV and bioethics at the Johns Hopkins School of Public Health have recommended that antiretroviral treatments be considered for pregnant women with HIV, and that more research be conducted on the safety of treating pregnant women with underlying disease. In the early years of the HIV epidemic, pregnant women with the disease were not given medication out of concern over potential harm to the fetus. According to the researchers, however, this cautious policy of non-treatment can result in both maternal and fetal harm. Their recommendations were published in the April issue of the American Journal of Obstetrics/Gynecology.

Lead author Nancy E. Kass, ScD, associate professor, Department of Health Policy and Management and director, Program in Law, Ethics, and Health, Johns Hopkins School of Public Health, and senior faculty, Bioethics Institute, Johns Hopkins University, said, "While we share the belief that fetal protection is imperative, we hope providers consider the very serious harm of simply assuming that treatment avoidance is safer. Clinical decisions always must be made cautiously and thoughtfully - and with the understanding that what serves the health needs of pregnant women is usually what is in the best interests of the developing fetus and future child."

The experts reviewed how policy and treatment guidelines for HIV have addressed pregnancy over the past 15 years. Because of overriding concern for fetal protection, little clinical research has been conducted with pregnant women that might demonstrate the relative risks of treating versus not treating a pregnant woman's underlying HIV infection.

According to the researchers, clinicians and government policy-makers are beginning to recommend interventions that better serve the interests of pregnant women and their future children. In order to avoid the small number of cases in which medications are given inappropriately during pregnancy, providers have been withholding treatment that would be effective for many pregnant women infected with HIV.

This work was supported in part by a grant from the American Foundation for AIDS Research.