AZT Roulette: The Impossible Choices Facing HIV-Positive Women

By Celia Farber
Web Exclusive

Kris Chmiel is a housewife and mother of two young children, living in Denver. When she was pregnant with her second child, a movement had just gotten underway to test all pregnant women in the state of Colorado for HIV, the virus widely believed to cause AIDS. (Critics remind us that what is tested for is not, in fact, HIV, but antibodies to HIV.) She was perfectly healthy and in her first month of pregnancy. She wasn't worried - she had been monogamous with her husband for the past nine years. When the test came back "positive," she literally did not believe it.

Her doctors strongly urged her to immediately start taking the AIDS drug AZT, in an effort to prevent transmission to her child. "They finally wore me down," she says, "even though it was totally against my intuition."

In her fifth month of pregnancy, Chmiel began taking 500 milligrams of AZT, a drug that has been routinely given to pregnant HIV-positive women following a 1994 study - ACTG 076 - which claimed efficacy in reducing the transmission from mother to child.1 (AZT stands for azi-dothymidine and is marketed under the names Zidovudine or Retrovir.)

Chmiel’s daughter is two years old today, and has twice tested negative for HIV infection. By the standards of the AIDS establishment, she is not only a success story, but the very epitome of medicinal victory - perhaps the only "victory" in the entire realm of AIDS research. She is precisely the kind of baby who would serve as a poster child for those forces that are pushing hard for mandatory testing, as well as mandatory treatment, and maybe even mandatory AZT use by all pregnant women - a "saved" baby.

But to Chmiel, there are strong undertones of regret, anger, and even despair when she thinks back on her choice to take AZT. Follow-up HIV tests after her child was born gave results different from the first one, throwing into question whether she ever did have HIV. One test was indeterminate, and another was negative. She soon started doing her own research, and found a paper citing all the underlying conditions - as many as 64 - that can cause a false positive HIV-antibody test. One of them is pregnancy. (See"How Accurate Is the HIV Test" )

She also became more and more aware of the potential toxic effects of AZT, which, although it is said to be "safe" for both mother and child, is a known carcinogen, mutagen, and teratogen - a drug long classified as "contraindicated’’ in pregnancy. For Chmiel, who stayed on AZT for a year after her child was born, the breaking point with AZT came when the drug’s toxicity became so overwhelming that she crawled to the bathroom and kept vomiting for hours. "I just couldn’t take it anymore," she says, adding that when she stopped taking the drug, her health returned.

There are five categories that the FDA uses for pregnancy drug classification, listed from the safest to most dangerous - A,B,C,D, and X. AZT is listed in Category C and is described as a drug in which "safety in human pregnancies has not been determined, animal studies are either positive for fetal risk or have not been conducted, and the drug should not be used unless the potential benefit outweighs the potential risk to the fetus."

In the case of AZT and HIV, the "risk" is a variable that is inextricable from a core question that hasn’t been resolved, namely, "Does a positive HIV antibody test predict an inevitable progression to sickness and death?" Some experts say yes, others say no. (See "Does HIV Cause AIDS?" ) Several studies, particularly in recent years, have noted how an increasing number of children born HIV positive are growing into adolescence without any sign of sickness. A study that came out of the 1996 International AIDS Conference in Vancouver reported that 37 percent of all HIV-positive babies would never progress into full-blown AIDS.2 In his landmark book Rethinking AIDS, Dr. Robert Root-Bernstein states, "Less than a third of HIV-sero-positive infants go on to develop AIDS."3

It may be nearly impossible to ferret out what precisely we mean when we talk about children "progressing," because the waters are clouded from the start. Progressing from what to what? As Root-Bernstein points out, 80 percent of HIV-positive infants in the US are born to drug-addicted mothers - whose immune systems are severely compromised with or without HIV - and those babies all will inherit their mother’s immune system. If the mother is sick, the baby will be sick.

Unfortunately, few research efforts have been aimed at truly resolving the fundamental question of how HIV, as distinct from all other factors, affects children, because mainstream HIV dogma holds that there is no question. If a mother has HIV, she and her child will be viewed through the lens of HIV, and not seen in the context of their whole immediate environment - although, as Root-Bernstein documents extensively, babies born to HIV-positive mothers often have identical health profiles to their mothers, whether these babies are positive or negative.4