Drug prophylaxis for human immunodeficiency virus-infected pregnant women: ethical considerations

Article Abstract:

The prevalence of pregnant women with HIV (human immunodeficiency virus, which causes AIDS) is increasing. Prenatal HIV counseling is increasingly being offered. Many women agree to testing because of the availability of zidovudine, the only approved anti-HIV medication, and pentamidine, which is effective in prevention of the HIV-associated pneumonia, PCP (pneumocystis carinii pneumonia). The CDC (Centers for Disease Control) recommend against use of pentamidine as a prophylactic (preventive) agent in pregnant women. The availability of pentamidine and other drugs used to treat HIV and its complications should be discussed with HIV-infected pregnant women as part of informed consent procedures and appropriate care. In other instances of pregnant patients faced with medical difficulties, they are freely counseled by physicians about therapeutic options and usually then choose the option they consider best for themselves and for the fetus. Neither zidovudine nor pentamidine therapy is known to endanger the fetus absolutely, nor is life of an HIV-infected individual known to be much shorter if these therapies are deferred for the duration of pregnancy. If the outcomes of these therapies were clearer and much more absolute, then withholding or definite recommendations for usage would be justified. Discussion of these treatment options falls logically into the consideration of the many other decisions that must be made during the pregnancy of an HIV-infected woman, such as who is to care for the child if the mother becomes incapacitated. Rather than expecting that maternal and fetal interests will conflict, the obstetrician should consider this situation as being similar to any other one in which any pregnant woman with a life-threatening disease needs treatment. Another aspect is that most HIV-infected infants are born to women who are black or Hispanic, poor, and underinsured, but who nevertheless deserve to be the focus of the physician's concern. Denial of information to such women continues a process in which they receive less than the care they deserve. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Ethical aspects, AIDS (Disease), AIDS (Disease) in pregnancy, editorial

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The cost-effectiveness of human immunodeficiency virus screening in pregnancy

Article Abstract:

Screening pregnant women for the presence of HIV may be cost-effective in populations where the rate of infection is high. The cost savings may be realized from treating fetuses with anti-HIV drugs to prevent them from acquiring the virus from their mothers. Researchers used a mathematical model to determine the cost-effectiveness of HIV screening of pregnant women by varying population rates of HIV infection. The cost of preventing one infant from acquiring HIV dropped as the population infection rate rose, with screening producing a pediatric treatment cost savings at an infection rate of 15 per 1,000 people. HIV screening reached a point of being more cost-effective than not screening when the infection rate was nine per 1,000 people. HIV screening should be part of a comprehensive HIV program.

Economic aspects, Testing, HIV testing, HIV tests

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Treatment of human immunodeficiency virus during pregnancy: the shift from an exclusive focus on fetal protection to a more balanced approach

Article Abstract:

HIV-infected women who become pregnant should be offered the same treatment as a non-pregnant HIV-infected woman. Doctors often avoid treating pregnant women in order to prevent fetal abnormalities, but the health of the mother is also in the child's best interests.

Connecticut

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