Dear Correctional Colleagues:

In keeping with HEPP Report tradition, the treatment of HIV-infected women is the focus of our May issue. I'm especially pleased to present Dr. Beth Weaver's report on mother-to-child transmission prevention (MTCP) in this issue. She provides updated guidelines on MTCP, but it's worth noting that these guidelines change rapidly. For example, it is highly likely that treatment of the HIV-infected woman presenting during labor will be modified to short course combination therapy (such as nevirapine and combivir, together, for at least one month following delivery), since single-dose nevirapine has been associated with high rates of resistance due to the long "tail" of detectable drug levels following administration. The best course to follow when confronted with lipodystrophy in an HIV-infected woman is, as yet, uncertain. Dr. Weaver provides a review of the most recent revelations related to this topic, gleaned from the February 2004 CROI conference. And, interestingly enough, this issue of HEPP Report also includes a discussion of contraception and antiretrovirals. Thus we are once again made aware that HIV-infected women are vibrant, sexually active and often still desire to have children. 

We need to pause, in this month of that celebrates maternity, to consider the prevalence of HIV infection among pregnant women all over the world. Just a few statistics of note: The prevalence of HIV infection among pregnant women in Bostwana is 32%. In Swaziland, the rate is 40%. In South Africa the rate is 50 %. In Zambia the rate is 69%. These statistics are sobering ­and remind us that we should do all that we can to prevent the further transmission of HIV infection to babies, no matter what country we call home. 

Of course, neither sex nor pregnancy are events meant to occur during incarceration. We therefore bring you these updates so that you can better plan your care of women patients as they are being released back to the community. The fact is, your patients often resume their lives where they left off (without restarting illicit drug use, we hope). I always tell my soon-to-be-released patients to have more than one plan - Plan A and Plan B. Even though they may not be planning to get pregnant, I have a discussion with them about how best to manage their pregnancy, should it occur. The good news that all of our patients deserve to hear is that HIV transmission to the newborn does not have to happen. Therefore, as you are planning ahead for your Mother's Day celebrations, (May 9th this year, in case you were wondering!) do give some thought to future generations of children who will thank you for teaching your patients about Plan B. 

As always, we thank our readership for their interest in HEPP Report and we welcome your comments. 

Sincerely,
A. S. De Groot, MD

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