a Viral Legacy
Bardeguez, MD, MPH, professor in the Department of Obstetrics,
Gynecology and Women's Health and director of HIV services
at UMDNJ-New Jersey Medical School.
We can't shake our sense of guilt when we
meet Arlene Bardeguez outside the newborn nursery at UMDNJ-University
Hospital on a Monday morning in September. We know that she
had to juggle her schedule to carve out a quarter hour to
spend posing for the camera - and we're aware that picture-taking
does not quite match the seriousness of the other demands
of her day. She arrives late - apologizing but offering no
excuses - then organizes herself quickly and gives us her
full attention for that small space of time. That's her way.
She has an awe-inspiring line-up of activities on her calendar
for today, and every day, but at each stop, she gives her
It's her smile that captivates us. Warmth
and sincerity come shining through- this is a strong professional
woman who's all about taking care of others. Great good luck
was with the women and babies of Newark, and all of New Jersey,
when she chose her line of work, or it chose her.
A graduate of the University of Puerto Rico
Medical School, Bardeguez came to New York in 1981 to do a
residency in obstetrics and gynecology at Catholic Medical
Center in Queens. She clearly remembers her first encounter
with HIV/AIDS. She was asked to attend a lecture in 1982 on
the "gay men's disease," and questioned the relevancy to her
work, which entailed "doing deliveries and writing discharge
notes." But about six months later, she recalls seeing a woman
with oral thrush and wasting syndrome, who was pregnant and
eventually died. "She was one of the first reported cases
of a pregnant woman who had HIV infection," Bardeguez says.
"We actually ended up having two patients
with no known risk factors for the disease. The other came
in with a cough and was treated several times for a presumed
upper respiratory infection, and ended up dying of full blown
PCP pneumonia. We then tracked her history and found that
her first husband was an IV drug abuser," the physician says.
"So I soon became very sensitized that this is affecting women
who are not necessarily IV drug abusers. But I never really
planned to follow that career because it was sort of a dead
end. I mean, there was no hope at that point."
Hope came later, but certainly too late for
many. In the meantime, Bardeguez completed her residency in
'85 and a fellowship in maternal and fetal medicine at Nassau
County Medical Center in '87. She chose to concentrate on
high risk obstetrics, taking care of pregnant women with diabetes,
high blood pressure and other chronic conditions, as well
as those with drug and alcohol addictions. When she began
working in Newark that year, the number of HIV-positive women
was climbing steadily and many of their infants were coming
into this world already infected with the virus and doomed
to die very young. Some of those women were receiving no prenatal
medical care, and were showing up at the hospital ready to
deliver their babies. In many cases, the women did not even
know they were HIV-infected until their babies tested positive
for the virus.
When the AIDS epidemic took hold in this country,
a diagnosis of the disease was generally a death sentence.
But by the mid- to late-'80s, AZT and prophylaxis for PCP
and TB were incorporated into the care of this population,
and proved to be life-savers, literally snatching terminally
ill patients from death's grip.
Bardeguez added to her high-risk obstetrics
practice women infected with HIV, who were also often riddled
with other major medical problems. She teamed up with pediatric
AIDS specialist James Oleske, and others, to focus on this
fairly invisible, but hard-hit, group. Many of the women were
poor and most were minorities, and they were taking care of
their families, but not themselves. It became a chilling point
of conversation in the medical community that the women would
not seek medical treatment until they were so ill that they
could no longer function in their family roles. At that point,
it was often too late to save them, and sometimes too late
to save their babies. The term "boarder babies" was coined
for those infants left behind in the hospital by HIV-infected
mothers who could not take care of them.
It was those women, and their babies, who
Bardeguez championed, and still does. She and Oleske launched
a controversial, but ultimately very successful, nationwide
clinical trial testing if AZT, administered to pregnant HIV-positive
women during their pregnancies and during the birth process,
and to the infants for six weeks after birth, could stem transmission
of the virus from mother to child. "And lo and behold," says
Oleske, "we saw instead of the 30 percent of infants being
infected and sick and dying of AIDS, it went down to 8 percent."
Bardeguez points out that before this trial,
physicians always advised women to stay away from all drugs
during pregnancy, and so this was a radical idea. At that
time, she says, AZT had to be taken five times a day, which
required the women to be deeply committed to this protocol.
Also, newborns were being given a powerful drug, and there
was no data to indicate they could tolerate it, or that it
would do them any good.
The care of HIV-infected women was also modified
to decrease the prevalence of other contributing factors for
perinatal HIV-1 transmission by providing treatment and prophylaxis
of sexually transmitted diseases such as herpes, referral
to substance abuse programs, prevention of preterm labor by
behavior modification and considering operative delivery when
all else failed. Finally, in the late 90s, cohort studies
showed the relationship between reducing HIV viral load and
reducing the transmission rate, so an aggressive approach
to decrease viral load in pregnant women with the use of HAART
(Highly Active Anti-retroviral Therapy) was recommended by
the U.S. Public Health Task Force. Implementation of all these
strategies resulted in lowering the perinatal transmission
rate in the U.S. to 1 to 2 percent, although it still hovers
between 25 and 40 percent in the rest of the world.
and her research team continue to participate in clinical
trials - now concentrating on the evaluation of safety and
pharmacokinetics of different combinations of antiretroviral
drugs for maternal safety and to further decrease the transmission
rate. More than two decades after HIV was first reported,
women of all ages, races and ethnicities continue to get infected
in this country and worldwide. "We have acquired new knowledge
in the management of these pregnancies and their long-term
outcome because of the unselfish willingness of many women
to participate in studies and clinical trials. But until we
get a cure, there is still work to do," says Bardeguez.
the doctor and her team remain tireless in working on behalf
of these women and their families. It takes an extraordinary
amount of a doctor's time to ensure that each HIV-infected
woman who enters UMDNJ-University Hospital in Newark has a
safe and healthy pregnancy, and delivers a healthy baby. But
Bardeguez has also assumed a leadership role in bettering
the lot of all HIV-infected pregnant women and their children
worldwide. She never questions whether she made the right
choice in her specialty, because she knows how much her efforts
count in ensuring that the legacy bestowed from one generation
to the next will not include this dreaded virus.
whose work has been recognized with a New Jersey Pride Award
in 1999 and an Edward J. Ill Award, given by the Academy of
Medicine of New Jersey, in 2001, is the only maternal and
fetal medicine specialist in New Jersey with HIV expertise
to make the list of America's "top docs."