“Antiretroviral therapy taken during pregnancy is not detrimental to bone development and bone health of the fetus/infant. Due to the awareness about the numerous side effects of antiretrovirals, we wanted to verify the safety for the fetus of the therapy,” said Dr. Stefano Mora from the Laboratory of Pediatric Endocrinology at the San Raffaele Scientific Institute of Milan, Italy, and lead author of the study.

“In simple words, HIV-infected mothers should take their therapy and do not have to worry about the bone health of their children,” he added.

Antiretroviral therapy during pregnancy is important for preventing mother-to-child transmission of HIV. However, according to the study authors, antiretrovirals have been linked to decreased bone mass and altered bone metabolism in HIV-positive children and adolescents.

Viread (tenofovir), which is also a component of Truvada (emtricitabine/tenofovir), has been particularly linked to bone loss in HIV-positive children and adults (see related AIDS Beacon news).

In this study, the researchers investigated the effect of antiretroviral drug exposure during pregnancy on newborns and infants.

The study included 38 infants who were exposed to antiretrovirals during pregnancy. The infants were born between 35 and 39 weeks of gestation. For comparison, the study also included 94 newborns with HIV-negative mothers, born between 37 and 40 weeks of gestation.

More than half (58 percent) of the HIV-positive mothers were taking two nucleoside reverse transcriptase inhibitors (NRTIs) and a protease inhibitor, and a quarter (24 percent) were taking two NRTIs and one non-nucleoside reverse transcriptase inhibitor.

The mothers received one of the following NRTI backbones: Epivir (lamivudine) plus zidovudine (Retrovir), Epzicom (abacavir/lamivudine), Epivir plus didanosine (Videx), or Truvada.

The median length of infant exposure to antiretrovirals during pregnancy was 14 weeks. All mothers had cesarean sections, and all newborns received antiretroviral therapy and were formula fed to avoid mother-to-child HIV transmission.

Measurements of bone development were obtained as soon as possible after birth and prior to hospital discharge. Further measurements were taken at follow-up visits four and 12 months after birth.

Results showed that antiretroviral-exposed infants had lower weight and length measurements at the beginning of the study and at their four-months follow-up visit, due to shorter gestation times compared to unexposed infants. However, these differences were no longer significant at age 12 months.

Ultrasound measurements of the shinbones of exposed and unexposed infants showed that there was no difference in bone quality or maturation between the two groups. Results also showed that bone formation and bone break down or loss (bone resorption) rates did not differ between the two groups.

A separate analysis showed that there were no significant differences in bone development in infants exposed to Viread or Truvada; however, the researchers noted that further studies are needed to confirm this observation.

For more information, please see the study in the journal Bone (abstract).

Office Of National AIDS Policy To Hold Discussions On National HIV/AIDS Strategy – The Office of National AIDS Policy is planning to hold several discussions with members of the HIV community, including researchers, clinicians, and people with HIV, on implementation of the National HIV/AIDS Strategy. The first talk will be at the University of Alabama in Birmingham on September 27 and is entitled “Incorporation of Prevention and Care Research Into HIV Programs.” Additional talks will be held October 4 in Seattle; October 20 in Philadelphia; late October in Baton Rouge, LA (date to be decided); and early November in Des Moines, IA (date to be decided). Additional dates and locations will be announced later. For more information, please see the AIDS.gov website.

Atlanta Police Department Sued For Discriminating Against HIV-Positive Man – An HIV-positive man who was denied a job as a police officer in Atlanta after a pre-employment medical exam revealed his HIV status has sued the city of Atlanta for discrimination. The man claims that the city violated the Americans with Disabilities Act (ADA) and other federal and state laws; HIV is considered a protected illness under the ADA. Atlanta claims that the man was rejected for reasons other than his HIV status, but that they were also justified in not hiring him because his status represents a “direct threat” to the health and safety of others. For more information, please see the article in The GA Voice.

AIDS Institute Releases New Guidelines On HIV Testing And Treatment During Pregnancy – New York’s AIDS Institute has released two new guides, “HIV Testing During Pregnancy and at Delivery” and “Acute HIV Infection in Pregnancy.” The guides are the first two sections of a new set of guidelines on managing HIV infection in pregnant women. The remaining sections will be posted as they are completed. The guidelines are being formulated in cooperation with the Johns Hopkins University Division of Infectious Diseases. For more information, please see the HIV Testing During Pregnancy and at Delivery and Acute HIV Infection in Pregnancy guidelines.

The authors of the review also found that assisted reproduction options can help people with fertility problems and can be a safe choice for HIV serodiscordant couples (a couple in which one partner is HIV positive and the other is HIV negative), although the risk of HIV transmission cannot be eliminated completely.

Based on their results, the authors suggested more research into future fertility treatments designed to minimize the risk of transmission, as well as further studies to evaluate the effects of HIV and antiretroviral therapy on fertility in people with HIV.

Prior to the advent of highly active antiretroviral therapy (HAART), the prospect of parenthood raised a number of issues for people with HIV, including a high risk of transmission to a partner and to the infant before or after birth. However, the use of antiretrovirals has significantly decreased mother-to-child transmission of HIV, with rates of transmission as low as 1 percent in the United States.

HIV is most common among people of reproductive age. As a result, a growing number of people with HIV desire to have children and are planning to become pregnant (see related AIDS Beacon news).

In this review, the authors addressed the potential role of HIV and antiretrovirals in people with HIV and infertility issues, as well as treatment options and fertility procedures for infertile and serodiscordant couples.

Infertility In HIV-Positive Women And Men

Results on the causes of infertility in men and women with HIV have been conflicting, but in general appear to indicate that people with HIV, particularly people with advanced HIV infections or AIDS, are less fertile than HIV-negative men and women.

Results of a study of African women with HIV showed that they were 25 percent to 40 percent less fertile than HIV-negative women. In addition, some studies have shown decreased fertility rates in HIV-positive women in the United States.

However, according to the review authors, it is still unclear whether HIV itself causes infertility or whether the problem is due to other conditions that women with HIV are more prone to. For example, additional factors that may result in infertility in HIV-infected women include stress, weakened immune systems, weight loss, drug abuse, and the presence of other sexually transmitted diseases.

Attempts to determine the role of HIV itself in infertility have had mixed results. HIV-positive women are more likely to have an anovulatory cycle, a common cause of infertility in which a woman has a menstrual cycle without the ovaries releasing an egg. HIV-positive women are also more likely to have amenorrhea, or a complete absence of a menstrual cycle in a woman of reproductive age.

However, the causes of anovulation and amenorrhea in HIV-positive women are unknown, and recent studies suggest that HIV infection itself is not linked to amenorrhea once other factors, such as weight and age, are taken into account.

Some studies have also suggested a link between HIV infection and ovarian failure in HIV-infected women. For example, researchers in one small study found that 8 percent of HIV-positive female participants had levels of the follicle-stimulating hormone, a hormone required for growth and development in the ovaries, similar to those in menopausal women. However, a larger study found no such link between the hormone and HIV, and another found no evidence of premature ovarian aging in HIV-positive women.

For women who are not on antiretroviral therapy, complications with pregnancy may occur more often. In one study, almost 19 percent of HIV-positive women experienced pregnancy loss compared to 12 percent of uninfected women. However, more recent studies have shown that HAART reduces pregnancy loss in women with HIV.

In men, studies have shown that several sexual problems that affect fertility are more common with HIV infection. Men infected with HIV, particularly men with advanced HIV, are more likely to have inflammation of the testicles and are more likely to produce insufficient testosterone levels.

Also, men with HIV are more likely to experience decreased sex drive and an estimated 60 percent experience erectile or ejaculatory dysfunction.

Sperm function also appears to be affected by HIV, with healthier men having fewer problems with their sperm. According to the review authors, men with higher CD4 (white blood cell) counts tend to have better semen volume, sperm motility, and sperm counts, all of which affect fertility, than men with lower CD4 counts.

Effects Of Antiretroviral Therapy On Fertility

The effects of antiretrovirals on fertility have also been unclear. Since advanced HIV infection tends to decrease fertility, starting HAART can improve the likelihood of pregnancy. However, there are also indications that the drugs can have negative effects on fertility.

Researchers from a study in Africa found that the use of antiretroviral therapy increased fertility in HIV-positive women (see related AIDS Beacon news). A study in the U.S., however, found that women on therapy were less likely to conceive. The reason for the difference in results is not clear.

In addition, according to the review authors, the use of some antiretrovirals, particularly zidovudine (Retrovir) and other older nucleoside reverse transcriptase inhibitors (NRTIs), may affect fertility in people with HIV.

Previous studies have shown that NRTIs, particularly older NRTIs, may cause damage to mitochondria, which are small structures within cells that supply cellular energy. In particular, NRTI use may damage the mitochondria in sperm and eggs, leading to infertility.

Other studies have shown that HIV-positive men on HAART may have damaged sperm, decreased sperm count, and decreased sperm motility.

Fertility Treatment Options For People With HIV

For people with HIV who have fertility problems or who have an HIV-negative partner and are worried about transmitting the virus, assisted reproductive technology can achieve pregnancy by artificial or partially artificial means.

Three common assisted reproduction techniques include intrauterine insemination, in vitro fertilization, and intracytoplasmic sperm injection.

Intrauterine insemination is a procedure where the sperm is placed directly in the woman’s uterus. In vitro fertilization, another technique, involves fertilizing eggs with sperm outside the body and then transplanting the embryos into the uterus. Finally, intracytoplasmic sperm injection is an in vitro fertilization process in which a single sperm cell is injected directly into an egg. For men who are HIV-positive, these procedures are combined with sperm washing, which separates virus and infected immune cells from the sperm.

All three techniques have been used successfully in people with HIV, and none of the studies reviewed by the authors had any instances of transmission in serodiscordant couples. However, the authors noted that before trying to conceive, patients should reduce the risk as much as possible using HAART to suppress levels of the virus.

The authors also noted that people with HIV can face many difficulties in accessing reproductive health care. Currently, fewer than 3 percent of U.S. fertility practices provide assisted reproductive services to HIV-positive patients.

In addition, the Centers for Disease Control and Prevention have not endorsed in vitro fertilization or intracytoplasmic injection for people with HIV, and many states outlaw placing bodily fluids from an HIV-positive person into a patient.

However, the review also highlighted a report from the American Society of Reproductive Medicine that suggested that discriminating against HIV-positive patients may be illegal under the federal Americans with Disabilities Act, since HIV and AIDS are considered disabilities by the government.

For more information, please see the study in Fertility and Sterility (abstract).

The researchers speculated that gender-based issues were not discussed during visits with the women’s health care providers because clinicians had a lack of experience, comfort, or knowledge of these issues or expected that patients’ concerns would be attended to by other physicians.

“Clinicians caring for HIV-infected women need to incorporate regular discussions about the reproductive plans of their patients. These plans change over time and clinicians need to modify their recommendations and treatment strategies accordingly,” said Dr. Kathleen Squires, a physician at Jefferson Medical College of Thomas Jefferson University in Philadelphia and lead author of the study.

“The study suggested that there is substantial room for improvement to reach this goal,” she added.

Based on their results, the study authors recommended that practitioners discuss issues such as family and pregnancy planning with HIV-positive patients. They also recommended that clinicians discuss other treatment-related psychological, social, and emotional aspects of HIV and offer routine screening for depression and other problems.

The proportion of women with HIV in the United States has increased over the past two decades. As of 2006, women comprised about one quarter of the HIV-positive population in the U.S.

According to the study authors, HIV-positive women face a unique set of health, social, and psychological problems. HIV and antiretroviral therapy may affect women differently than men. Also, rates of depression tend to be higher among HIV-positive women compared with HIV-positive men.

In addition, the use of highly active antiretroviral therapy during pregnancy, together with use of caesarean sections and avoidance of breast-feeding, have reduced rates of mother-to-child HIV transmission in the U.S. to less than 2 percent. As a result, more women with HIV may consider pregnancy and childbirth.

However, there is little information available on the effectiveness with which medical providers address potential pregnancy in women with HIV, and few studies have examined the gender-specific health needs of women with HIV.

In this study, researchers conducted a survey with 700 HIV-positive women to get feedback about communication barriers with their health care providers. Participants were recruited from 29 AIDS information, counseling, and treatment centers across the U.S.

Participants had a median age of 42.5 years and had been receiving antiretroviral therapy for an average of eight years. Two hundred of the women were Caucasian, 200 were Hispanic, and 300 were African-American.

Concerns About Gender, Racial Differences In HIV Progression And Treatment

More than half of the women (55 percent) had never discussed gender-based differences in treatment response with their practitioners, even though 46 percent of the women thought their disease affected them differently than men. Caucasian and African-American women were least likely to have discussed this issue with their HIV health care providers. Also, women with male health care providers were less likely than women with female health care providers to have discussed this topic (41 percent versus 51 percent, respectively).

However, 96 percent of women who did discuss gender-based differences in treatment response with their practitioners were satisfied with the answers they received.

More than half of the women (59 percent) felt that their culture, ethnicity, or language affected the care they received. Hispanic and African-American women were more likely to report this issue than Caucasian women. Also, women in the South were more likely to report this issue than women in the West or Northeast.

About one third of the women had seen three or more providers since starting HIV treatment, and 43 percent said they had changed providers because of communication issues.

Childbearing And Caregiver Issues

More than a third of the women (39 percent) had children. Of the women who had been pregnant prior to the survey or who were considering pregnancy, nearly half (48 percent) were never asked by their health care providers if they had or were thinking about having children. More than half (57 percent) had not talked about treatment options with their practitioners before becoming pregnant.

Of the women who were pregnant or had been pregnant at the time of the survey, 42 percent were either “not very aware” or “not at all aware” of the treatment options available to pregnant women with HIV.

Overall, 61 percent of women felt they could have children if given appropriate medical care but 59 percent felt society strongly discourages them from doing so.

Women with HIV who lived in the South were more likely to feel society discouraged them from having children than those living in the Northeast or Midwest. Those who received care from a nurse practitioner or physician assistant were also less likely to experience this attitude than those treated by infectious disease specialists or general practitioners.

Fifty-two percent of the women identified themselves as caregivers, and 43 percent said living with HIV has made it harder for them to look after their families. More women in the South compared with the Northeast felt this way (50 percent versus 37 percent, respectively).

The researchers speculated that concerns about stigma may encourage women with HIV, especially those who are caregivers, to keep their HIV status confidential as long as possible and hesitate to seek early care.

Social Support And Depression

Most women in the survey thought factors such as suppressing viral load (amount of HIV in the blood), achieving long-term success with medications, and being able to live normal lives were important aspects of their treatment.

Women who wanted extra support beyond what their practitioners could provide found it through support groups, therapists, family, and friends. Most Caucasian women identified therapists as sources of additional support, while Hispanic and African-American women mostly identified support groups.

Women in the Midwest and Northeast were more likely to get extra support from a support group or therapist, while women in the South were more likely to get support from family and friends.

Seventy-three percent of women said they had struggled “a great deal” or “somewhat” in managing their daily lives, while one third of the women experienced changes in sleep patterns, loss of energy, unexplained aches or pains, feelings of sadness or worry, and anxiety.

In addition, 27 percent had five or more feelings commonly associated with depression, although other studies have reported higher rates of depression among HIV-positive women.

A majority of the women (58 percent) said they were comfortable talking to their providers about their depression-related feelings, but women in the South were less likely to feel comfortable than women in the rest of the country.

For more information, please see the study in AIDS Patient Care and STDs.

The authors of the review suggested that couples in which only the man is HIV positive can safely use assisted reproduction technology to avoid HIV transmission to their uninfected partners and newborns.

However, they also noted that the men in the studies were often required to have low viral loads and high CD4 counts, so the results may not be applicable to couples in which the male partner does not have a controlled HIV infection.

A serodiscordant couple is a couple in which one partner is HIV positive and the other is HIV negative. The prospect of transferring an HIV infection from one partner to another has long been an obstacle for serodiscordant couples who want to have a baby. Unprotected intercourse is associated with a 0.1 to 0.3 percent risk of transmitting HIV each time.

Assisted reproduction technology can achieve pregnancy by artificial or partially artificial means. It is used for couples with fertility problems but can also be used for couples who are discordant for certain communicable diseases, such as HIV, to reduce the risk of transmitting infection.

Intrauterine insemination, in vitro fertilization, and intracytoplasmic sperm injection are three common assisted reproduction techniques.

Intrauterine insemination is a procedure where the sperm is washed to remove virus and then placed in the partner’s uterus. In vitro fertilization is a process in which eggs are fertilized with sperm outside the body and then inserted into the uterus. Intracytoplasmic sperm injection is an in vitro fertilization process in which a single sperm cell is injected directly into an egg.

Results from previous studies have suggested that using assisted reproduction techniques can reduce the risk of HIV transmission in couples where the man is HIV positive and the woman is HIV negative. Nonetheless, there has been controversy regarding the safety and efficacy of assisted reproduction techniques in HIV serodiscordant couples.

The authors of this study reviewed 17 studies from Europe and the United States on the use of assisted reproduction techniques for HIV serodiscordant couples in which the man is HIV positive. The review included 1,184 couples who underwent intrauterine insemination and 579 couples who used in vitro fertilization or intracytoplasmic sperm injection.

The maximum participant viral load (amount of HIV in the blood) reported was 49,000 copies per milliliter of blood, and the minimum CD4 (white blood cell) count was 400 cells per microliter of blood. However, the majority of studies included restrictions on viral load and CD4 count as eligibility requirements for participating in the study.

The authors reviewed the rates of HIV positivity in washed semen, frequency of HIV transmission, and pregnancy and miscarriage rates.

The results of the review showed that approximately 2.5 percent to 8 percent.of washed semen samples tested positive for HIV, although only 4 of the 11 studies reported post-wash sample testing.

The results also indicated that none of the women or their newborns tested positive for HIV at birth or after three to six months.

For all serodiscordant couples reviewed, the rates for successful pregnancy were similar to rates seen in the general population. The median pregnancy rate was between 50 percent and 53 percent.

The median miscarriage rate was between 16 percent and 21 percent, which is higher than in studies of the general population. This may have been due to a slightly higher average maternal age (33 to 38 years).

For more information, please see the study in Fertility and Sterility (abstract).

The exception is for treatment-experienced pregnant women in their second or third trimester who are also taking antiretrovirals containing tenofovir, which include Viread (tenofovir), Truvada (emtricitabine/tenofovir), and Atripla (efavirenz/emtricitabine/tenofovir). These women will need to increase their Reyataz (atazanavir) dosage from 300 mg to 400 mg daily.

Treatment-experienced women who take antacids in the H2-receptor antagonist class, which include cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid), and nizatidine (Axid), should also take a 400 mg dose of Reyataz daily.

The new information notes that women should be monitored for side effects for up to two months after delivery. Babies should be monitored for side effects for their first few days after birth.

“This labeling update is important news for both health care providers and HIV-positive women of child-bearing age in that it provides guidance for the use of Reyataz, as part of combination therapy, during pregnancy and postpartum,” said Dr. Awny Farajallah, an executive director at Bristol-Myers Squibb, in a press release.

Reyataz is a protease inhibitor that is currently approved as a once-daily treatment for HIV, in combination with other antiretrovirals. It is usually taken with the booster Norvir (ritonavir), which increases blood concentrations of protease inhibitors to make them more effective.

Reyataz is only recommended for women during pregnancy if the benefits outweigh the potential harm. Reyataz is classified as a pregnancy class B drug, meaning there is no evidence that Reyataz increases the rate of birth defects but that its safety for the fetus has not been adequately established in human clinical trials.

Reyataz is not approved for preventing transmission of HIV from mothers to their babies. Zidovudine (Retrovir) must still be administered during pregnancy to prevent transmission.

The updated prescribing information is a result of a recent study evaluating Reyataz in 41 HIV-positive pregnant women in their second and third trimesters. The purpose of the study was to see if the normal Reyataz dosage – 300 mg daily plus 100 mg of Norvir – is sufficient to maintain adequate Reyataz blood levels during pregnancy, or if the dose needs to be increased to 400 mg daily.

All of the women in the study had CD4 (white blood cell) counts of 200 or above. All women in their second trimester received 300 mg Reyataz. In the third trimester, half of the women were assigned the 300 mg dose plus Norvir, while the other half were assigned the 400 mg dose plus Norvir.

The women also received Combivir (zidovudine/lamivudine) to prevent HIV transmission to their babies.

Results showed that the 300 mg daily dose maintained adequate blood levels of Reyataz. Of the 39 women who completed the study, 97 percent achieved viral suppression (an undetectable amount of virus in the blood) by delivery.

The most common side effect was high bilirubin levels, which is a known side effect of Reyataz and can cause jaundice.

High bilirubin levels were observed in 30 percent of women taking the 300 mg dose and in 62 percent of women taking the 400 mg dose.

Among the 40 infants born to the study participants, 28 percent had high bilirubin levels at birth; however, none of these cases were considered severe. Three babies (8 percent) had low blood sugar levels at birth.

None of the babies in the study tested positive for HIV at birth or after six months.

Bristol-Myers Squibb noted that the study included mostly African-American newborns (83 percent), who are less prone to high bilirubin levels than Caucasian or Asian infants.

The study investigators also excluded women who had previously had babies with hemolytic disease, an immune condition that can cause anemia and high bilirubin levels, or babies with jaundice that needed light therapy for treatment.

For more information, please see the Bristol-Myers Squibb press release.

Phase 2 Clinical Trial Recruits Treatment-Experienced HIV-Positive Adults For Treatment With Investigational Antiretroviral Drug – A Phase 2 clinical trial, sponsored by Pfizer, is currently recruiting participants at over 70 locations nationally and internationally. The trial will test the safety and efficacy of UK-453061, a non-nucleoside reverse transcriptase inhibitor (NNRTI) under development, as compared to Intelence (etravirine) in treatment-experienced patients with NNRTI resistance. The trial will measure the number of study participants who achieve and maintain viral suppression (undetectable amounts of HIV in the blood) after 24 weeks. For more information, please see the U.S. Clinical Trials Registry.

Phase 2 Clinical Trial In Philadelphia Recruits HIV-Positive Injection Drug Users For Treatment With Investigational HIV Antibody – A Phase 2 clinical trial in Philadelphia will test the safety and efficacy of an investigational anti-HIV drug PRO 140 (anti-CCR5 monoclonal antibody) in HIV-positive injection drug users. The antibody drug, made by Progenics Pharmaceuticals, is an entry inhibitor that works in a similar manner as Selzentry (maraviroc); it is designed for people who have previously failed treatment and will supplement regular antiretroviral therapy. The drug is administered by injections under the skin rather than taken in pill form. The study will test to see how many study participants achieve and maintain viral suppression over a period of 24 weeks. For more information, please see the U.S. Clinical Trials Registry.

AIDSinfo Updates Fact Sheets On HIV And Pregnancy – AIDSinfo, a website run by the U.S. Department of Health and Human Services, has updated its factsheets on HIV and pregnancy. The updates take into account the most recent guidelines on treatment of HIV during pregnancy, released in May 2010 (see related AIDS Beacon news). A new factsheet on prevention of mother-to-child transmission of HIV has also been added to the website. For more information, please see the AIDSinfo website.

The guidelines were released by the Women’s Health Committee of the New York State Department of Health AIDS Institute.

The Committee recommends that HIV-positive women undergo the same routine physical and gynecological visits as uninfected women. All infected women should obtain an annual Pap test, a gynecological exam that checks for cancers or abnormalities in the cells of a woman’s cervix.

Women with irregular or absent menstrual periods who are pre-menopausal should obtain a pregnancy test, since pregnancy is the most common cause of absent periods in women. Irregular periods may indicate pregnancy complications such as a miscarriage or ectopic pregnancy, in which an embryo implants somewhere other than in the uterus.

The guidelines also recommend that women with abnormal bleeding keep a record of their menstrual and bleeding patterns for three months, including dates, amount of blood, and any other symptoms such as fever or pain.

Finally, as a precaution, the Committee recommends that HIV-positive women with abnormal bleeding or absent menstrual periods of unknown cause contact a gynecologist who is experienced with HIV for diagnosis and treatment.

The guidelines note that, for the most part, studies have shown that women with HIV have menstrual problems at similar rates as women without HIV. HIV-specific causes of abnormal uterine bleeding are rare.

However, there is some evidence that rates of two menstrual disorders, oligomenorrhea and amenorrhea, are higher in women with HIV, particularly in women with advanced HIV infections.

In oligomenorrhea, a woman’s menstrual period is infrequent and lighter. In amenorrhea, a woman’s menstrual period is absent altogether for three months or more.

Researchers have also found that women with HIV tend to have a higher occurrence of certain chronic conditions and diseases associated with menstrual irregularities, such as sexually transmitted diseases or cervical cancer.

In addition, factors such as smoking, poor diet, and emotional stress are more common in HIV-positive women and can be associated with the onset of menstrual disorders.

The guidelines include common gynecologic causes of menstrual irregularities in HIV-positive women, such as:

• Pregnancy
• Polycystic ovarian syndrome (PCOS), a hormonal disorder in which a woman’s eggs may fail to mature, resulting in lack of ovulation
• Ovarian insufficiency, a disorder in which women’s ovaries do not function properly
• Pelvic inflammatory disease, an inflammation of the uterus or other reproductive organs that can cause scarring and infertility
• Sexually transmitted infections
• Certain cancers, such as cervical cancer.

Common non-gynecologic causes of menstrual irregularities include:

• Stress
• Too much exercise
• Eating disorders
• Thyroid/pituitary disease
• Adrenal disease
• Weight loss
• Chronic diseases, such as diabetes, inflammatory bowel disease, or chronic immune suppression
• Certain medications, such as methadone, some psychiatric medications, and possibly protease inhibitors.

In general, studies have shown that infected women on antiretroviral therapy have fewer menstrual abnormalities than infected women not taking antiretrovirals.

For more information, please see the Women’s Health Committee guidelines at the New York State Department of Health AIDS Institute website.

Prior to the development of highly active antiretroviral therapy (HAART), pregnant HIV-positive women regularly delivered by Cesarean section (C-section), since vaginal births slightly increase the risk of passing the virus to the baby.

With the development of HAART in industrialized countries, however, a growing number of HIV-positive women choose to have vaginal deliveries. Because of this, researchers wanted to see if labor progression and delivery, including complications, are similar to those in uninfected women.

The study examined the medical records of 146 pregnant women infected with HIV who gave birth at Port-Royal Maternity Hospital in Paris between 2001 and 2006. The researchers also examined the records of 146 uninfected women for comparison.

All of the HIV-positive women in the study had achieved viral suppression (viral load, or amount of virus in the blood, of 50 copies per milliliter or less) by week 36 of their pregnancies.

In addition, none of the women in the study had any conditions that would preclude a vaginal delivery, such as pre-eclampsia (dangerously high blood pressure) or pregnancy with more than one baby.

Results showed that in most respects, there were no differences between HIV-positive and HIV-negative women. Babies from both groups had similar average birth weights and rates of neonatal hospitalization. There were no cases of mother-to-child transmission of HIV.

There were also no differences in the course of labor itself, including average duration, and HIV-positive women had similar rates of complications such as bleeding and infection.

However, the researchers did find that the maternal death rate was higher in HIV-positive women who had CD4 (white blood cell) counts less than 200 cells per microliter, possibly because of greater susceptibility to infections.

Women with CD4 counts greater than 200 cells per microliter had a similar maternal death rate as HIV-negative women.

Finally, the researchers noted that HIV-infected women were much less likely to be given an episiotomy, a procedure in which the skin between the vagina and anus is cut to facilitate a faster or safer delivery.

They suggested that physicians and midwives may be performing unnecessary episiotomies in uninfected women. In HIV-positive women, the possible transmission risks may deter excessive use of episiotomies.

The researchers pointed out that the study results will need to be confirmed by larger studies since their study was retrospective and small.

Under current U.S. guidelines, vaginal delivery is recommended if an HIV-positive pregnant woman has been receiving prenatal care and if her viral load is less than 1,000 copies per milliliter at 36 weeks of pregnancy.

For women with viral loads greater than 1,000 copies per milliliter at 36 weeks of pregnancy or with an unknown viral load, C-section delivery is still recommended. In addition, C-sections are recommended for women who have not received prenatal care until 36 weeks into the pregnancy or who have not received antiretroviral therapy.

For more information, please see the International Journal of Gynecology and Obstetrics (abstract).

Website Launched For 2010 National Latino AIDS Awareness Day – A new website has been launched for the 2010 National Latino AIDS Awareness Day (NLAAD). The website contains information on community events, HIV testing, and care for Latino/Hispanic-Americans. Resources are available in both Spanish and English. NLAAD will occur this year on October 15. For more information, please see the NLAAD website.

Black AIDS Institute And Merck Create New Black HIV/AIDS Advocacy Network – The Black AIDS Institute and the pharmaceutical company Merck have announced the establishment of the Black Treatment Advocates Network (BTAN). The goals of BTAN include improving HIV care and treatment for the African-American community, strengthening leadership and advocacy, and educating African-American communities about HIV and AIDS. The Network will sponsor regional training for advocates and will have an educational website. BTAN’s first action will be to set up pilot advocacy communities in Jackson, MS; Philadelphia; and Houston. For more information, please see the Black AIDS Institute and Merck websites.