Her Happy Ending for HIV Pregnancy
Arlene D. Bardeguez, MD, MPH, FACOG, professor, Department of Obstetrics, Gynecology & Women's Health, UMDNJ-New Jersey Medical School, and director, HIV Services, UMDNJ-University Hospital
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nce upon a time, HIV infected women were encouraged to forgo pregnancy. The risk of HIV mother to child transmission was too high and the maternal health outcomes were uncertain. If an individual did become pregnant, the fears about drug regimens with their potential side effects, or how this tricky virus might otherwise wreck the lives of mother and baby, were monumental. Then along came remarkably resourceful doctors like Arlene Bardeguez, MD, a high-risk obstetrician-gynecologist who has been there from the very start of the national clinical trials that would rewrite the medical books.
As the New Jersey Medical School obstetrical co-investigator for the very first trial to expose pregnant women to antiretroviral therapy in 1988 (known as the PACTG 076), which proved that drugs could reduce the perinatal transmission of HIV from mother to infant, Bardeguez has helped steer medical history. “We enrolled the first patient in that trial and had the first delivery.” She and her NJMS team were delighted by their success. “This protocol changed the approach to the care of HIV pregnant women here in the U.S. and globally. Furthermore, it supported the use of early HIV testing during pregnancy.”
Since then, participating in clinical trials — seven protocols — as principal investigator or team member has made her high-risk pregnancy practice quite extraordinary. Over the years, the research has been funded by the National Institutes of Health (NIH), National Institute of Allergy and Infectious Diseases, Division of AIDS and the National Institute of Child Health and Human Development. “At the beginning, I didn’t choose my career path but my experience in research and immunology, as well as a willingness to care for these women allowed me to witness the devastation caused by this disease.” Initially curious and empathetic, she soon became excited about getting positive results. “I recognized that I could help future and current generations to live healthy, productive lives.”
Yes, she still manages her share of ordinary obstetrical complications like multiple births or pregnant women with diabetes or hypertension, but the HIV cases are a continuing challenge. The clinical trials are offered to all HIV patients with no pressure to enroll, but for many women, they “bring hope. In recent years, we’ve focused on the pharmacokinetics and safety of the new antiretroviral therapies as well as the expanded treatment options which have brought new demands,” she admits. Those fluctuating hormone levels during pregnancy can affect the absorption of medication. “I take one day at a time, pray, surround myself with committed people who help make work more bearable, and recognize that good, bad and hectic days are part of living.”
And in the meantime, the children of her HIV-infected mothers are growing up. The oldest child born in the NJMS-University Hospital program under Bardeguez’s watchful eye is hardly a child at this point, having turned 18 last year.