Women and AIDS : Drug Use, Mother and Child - The HIV Connection

by Food and Drug Administration (FDA)

(Page 4 of 4)

Drug Use

Any illegal drug use puts a person at risk for HIV. An HIV-infected person who uses injection drugs and shares needles can pass the virus to someone else through tiny amounts of blood that remain in the needle or syringe.

Women who use non-injection drugs, especially crack and other forms of cocaine, also increase their risk for HIV because they may engage in risky sexual activity. Drug and alcohol use may cause a person to be less careful about choice of sex partners or to neglect to use a condom.

The Surgeon General's report advises:

If you use illegal drugs, try to get treatment to help you stop.

If you can't stop injecting illegal drugs, never share your equipment with anyone or reuse equipment used by someone else. HIV may be found in any equipment used to inject drugs, including needles, syringes, cotton, and "cookers" (containers used to mix and heat drugs for injection).

If you share or reuse injection equipment, clean and disinfect it between uses by flushing needles and syringes with water until they are visibly clear of blood and debris and then completely filling the equipment several times with full-strength household bleach. The longer the syringe is full of fresh bleach, the more likely the virus will be killed. (Some suggest the syringe should be full of bleach for at least 30 seconds.) After each bleach filling, rinse the syringe and needle several times by filling with clean water.

Cleaning injection equipment decreases the potential for infection but does not guarantee the equipment is sterile or all virus is killed. If you cannot stop injecting drugs, it's best to use only sterile needles and syringes.

More Work to Be Done

AIDS and other illnesses due to HIV infection are the fourth leading cause of death in American women aged 25 to 44. In New York and New Jersey, it's the number one cause of death for women in this age group.

"FDA is concerned about this trend," says Toigo. The agency is meeting with women's groups, professional groups, and activists representing women with AIDS in cities and rural areas, among minorities and underserved populations.

The meetings provide a forum for the agency to hear the concerns of those in the trenches and work with the groups to try to contain an epidemic that is increasingly affecting women, especially among minorities.

Mother and Child — The HIV Connection

According to the Surgeon General's 1993 report on HIV infection and AIDS, about 1 in 4 of babies born to HIV-infected women at that time became infected before or during birth. Scientists have been trying for some time to discover what influences whether or not a child will be affected.

No one is certain when viral transmission occurs. Possibilities include: during childbirth, from exposure to maternal blood or vaginal fluids; or earlier in pregnancy, when there may be a mixing of blood or passage of the virus across the placental wall.

In August 1994, FDA approved Retrovir (zidovudine, or AZT) for use in preventing transmission of HIV from infected pregnant women to their babies. Approval was based on results of a federally sponsored study showing that the risk of transmission to newborns from infected mothers is significantly reduced in women receiving zidovudine during pregnancy. Since its approval, AZT has been observed to reduce HIV transmission to infants from 25 percent in untreated mothers to 8 percent in those treated with AZT.

In response to reports of a study suggesting that very high daily doses of AZT increased certain types of cancer in baby mice, an independent NIH advisory panel unanimously agreed in January 1997 that the benefits of HIV-infected pregnant women taking AZT outweigh the theoretical concerns raised by the study. There are no reports of any human child developing cancer after AZT treatment and it is unclear whether the mouse study results apply to humans. The committee also recommended that pregnant HIV-infected women be told about the study before being given the drug and emphasized the need for careful long-term follow-up of all children born to pregnant women who received AZT.

To gain the most benefit from AZT therapy, women need to be diagnosed early in the course of their infection and before or early in the pregnancy. To this end, the Public Health Service recommended HIV counseling and voluntary testing of all pregnant women in the United States.

Apart from the timing of transmission, studies suggest that the likelihood of the child becoming infected may correlate with the mother's health during the pregnancy or birth. In the June 9, 1993, Journal of the American Medical Association, Michael E. St. Louis, M.D., and his colleagues reported that a baby is more likely to become infected if the mother is in the very earliest stage of infection (when the virus is thought to be abundant) or in an advanced stage of disease, or if the membrane surrounding the placenta is inflamed.

A child can also become infected after birth through breast-feeding.

The national Centers for Disease Control and Prevention had received reports of more than 6,000 cases of AIDS in children infected before or during birth or through breast-feeding, as of Dec. 31, 1995. Not surprisingly, experts predict that as more women of childbearing age become infected, the number of infected children will also rise. A disturbing prospect under any circumstances, the significance of this projection is most poignant for minorities in New York City, where AIDS is already the leading cause of death in Hispanic children 1 to 4 years of age and the second leading cause of death for African American children of the same ages.

About the Author

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FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.