 Table of Contents
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Introduction
Caring for women with human
immunodeficiency virus (HIV) or who are at risk for HIV is a challenging task for health
care providers in today's environment. Improving the Odds offers providers current
information on the reduction of perinatal HIV transmission based on the results of the
clinical trial ACTG 076 and more recent information about the medical therapy of people
with HIV. It also offers information on effective approaches for offering HIV counseling
and testing to women. Much of this information is adapted from the U.S. Public Health
Services' Program Advisory: Use of Zidovudine to Reduce Perinatal HIV Transmission in
HRSA-Funded Programs (HRSA, 1996) and the U.S. Public Health Service Recommendations for
Human Immunodeficiency Virus Counseling and Testing for Pregnant Women (Centers for
Disease Control and Prevention [CDC], 1995c), which was amended for use in Michigan by the
Maternal Child Health Advisory Committee's Subcommittee on Perinatal HIV Reduction.
During the past decade, HIV infection has become one of the leading causes of morbidity
among women. Women have accounted for one of the most rapid increases in cases of Acquired
Immunodeficiency Syndrome (AIDS) in recent years. As the incidence of HIV infection has
increased among women of childbearing age, increasing numbers of children have become
infected through perinatal (i.e., mother to infant transmission). Almost all children with
HIV infection acquire the virus by transmission from their mother. The risk of such
transmission in the absence of intervention is 15 to 30%, with estimates ranging from
13-45%. Infection is acquired in utero 20% of the time, and 80% of transmission occurs in
the peripartum period. Breast feeding also increases the risk of transmission.
Between 8,500 and 11,500 people in Michigan are estimated to have HIV disease. Of these,
69% are estimated to five in the Detroit metropolitan area. Nearly all of Michigan's 83
counties have persons living with HIV. About 80% of HIV/AIDS cases in Michigan are men and
20% are women. However, cases among women have increased faster than cases among men, so
that the gap between men and women is steadily narrowing. Women account for approximately
75% of an people who acquired HIV infection through heterosexual contact. Rates of
HIV/AIDS are seven times greater among blacks than among whites. Additionally, cases among
blacks are increasing faster than cases among whites. More than 75% of women with AIDS are
black. Three quarters of the infected population are adults age 25-44. This age group is a
major subset of the female population considered to be in their reproductive years.
Children and adolescents account for 3% of total reported HIV/AIDS cases. According to the
survey of women of childbearing age, approximately 80 women gave birth to HIV
perinatally-exposed children in 1993, while in 1994, approximately 60 women gave birth to
such children. The trend seen in this survey may indicate that HIV is decreasing among
women of childbearing age or that fewer HIV positive women are giving birth. However,
there are no firm data which indicate that HIV is decreasing among women who are not
giving birth.
This guide presents general approaches to medical management of pregnant women and their
infants. Because of the rapid development of new therapies for treatment of HIV infection,
this guide is not intended to represent the specifics of therapy in women infected with
HIV Women's health care providers caring for a pregnant woman with symptomatic HIV disease
should seek consultation from a clinician who has expertise in HIV disease and work
closely with the woman herself when making management decisions.
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