Is It Nature or Nurture?

HIV-positive women who become pregnant have a lower risk of progression to AIDS and death, according to researchers at Vanderbilt University Medical Center. Their findings, reported in early September in the online edition of The Journal of Infectious Diseases, suggest that the complex immunologic changes that occur during pregnancy could be interacting in a beneficial way with anti-HIV medications. Some previous studies in the developing world had reported higher levels of complications and deaths from AIDS complications among pregnant women, but those studies were conducted before the advent of combination antiretroviral therapy. The Vanderbilt study included 759 women treated between 1997 and 2004 at Nashville's Comprehensive Care Center, an outpatient HIV treatment program. More than 500 of these women received combination therapy, including 119 of the139 women who had at least one pregnancy during the study period. After using statistical models to adjust for differences between women--including their age, health, and response to therapy--the researchers found that 'pregnant women did better,' says Timothy Sterling, MD, the study's senior author. In addition, women who became pregnant more than once during the study tended to have a lower risk of disease progression than women who became pregnant only once. This also supports the conclusion, Sterling adds, that something about pregnancy is beneficial. However, more study is needed, he cautions. Pregnant women were healthier than the women who did not become pregnant, and they may have been more likely to adhere to their therapy out of concern for their fetus. The pregnant women also received what the researchers describe as intensive care--frequent visits with their physicians, case managers, and nutritional counselors. 'Efforts should be made to do that for everyone,' says Sterling, 'pregnant or not, female or male.'