Risky Business: Helping the HIV-Infected Have Babies
July 12, 1999
Web posted at: 3:43 p.m. EDT (1943 GMT)
by Jeffrey P. Kahn, Ph.D., M.P.H.
University of Minnesota
(CNN) -- Medical advances in treating HIV infection have changed the face of the epidemic. While in the not-so-distant past a positive HIV test meant waiting for the signs of illness and the inevitable demise associated with AIDS, today people feel better, live longer and are planning for the future. For a growing number, the hope is that the future will hold parenthood. But if one partner is not HIV-infected, trying to have a baby poses the risk of contracting the infection. And HIV infection in a pregnant woman poses a risk of infection to the baby she carries. What are the issues when someone with HIV infection tries to have a baby, and what can and should medical science do to reduce the risks?
Risk to partners
Trying to get pregnant the old-fashioned way poses small but significant risk when one partner is HIV-positive. Current data say that each time an uninfected person has unprotected sex with someone infected with HIV, there is about a 1 in 330 chance of becoming infected. One way to avoid or at least reduce this risk is to use artificial insemination so that there is no unprotected contact between partners. If the male partner is uninfected, low-tech artificial insemination prevents contact, and the virus cannot spread to him.
If the female is the uninfected partner, artificial insemination can help only if the sperm is first treated to reduce its ability to cause infection. This requires a new and as yet unproven technique called "sperm washing," an attempt to remove whatever virus is present and not part of the sperm itself. The "washed" sperm can then be used for insemination that will presumably pose less risk of infecting the woman. In addition, taking the same anti-viral drug regimen as someone with HIV may offer some protection from infection if the sperm is not virus-free.
But anti-HIV drugs carry sometimes serious side effects. It is not clear that the risks outweigh the benefits for someone who is otherwise healthy. And since the point of this effort is to become pregnant, the risks of anti-HIV drugs to the developing fetus must be considered -- risks for which there is little meaningful data.
Risk to babies
No matter how great the efforts at prevention, babies born to people infected with HIV will have some risk of HIV infection themselves. In an HIV-infected mother, the chance of infection for her baby can be reduced from nearly 30 percent to just over 5 percent if anti-HIV medications are taken during pregnancy. An HIV-infected father could pass the virus on to both his partner and the baby she carries, and unless she is tested during pregnancy, a woman may not even be aware of the risk.
Should doctors help people infected with HIV have children?
Should physicians help bring children into the world when at least one parent is infected with HIV, with the possibility that the child will be orphaned? Should they consider the burden to society that such families create? How should the risks to the child be considered, when the alternative to the risks of HIV is not to be born at all? Does reducing risks encourage HIV-infected people to act irresponsibly, or does it make safer what they would do anyway?
No one can look into a crystal ball and predict how a baby's life will turn out. HIV-infected parents are just one obstacle children may face, along with the risk of HIV infection for themselves. It is difficult to say that any of these obstacles is so great that it would better not to be born. Also, HIV infection can now be treated more effectively than ever. We can see that offering a way to decrease the risk of HIV to sexual partners and to babies doesn't necessarily condone risky behaviors that lead to HIV infection. Physicians can't prevent people from trying to have children. So if patients are heart-set on becoming parents, medical professionals have the opportunity to help them reduce the risk of infection. This means preventing cases of HIV rather than increasing them, and that is among the most important goals of all.
What are the issues when someone with HIV infection tries to have a baby, and what can and should medical science do to reduce the risks? Should physicians help bring children into the world when at least one parent is infected with HIV, with the possibility that the child will be orphaned? Should they consider the burden to society that such families create? How should the risks to the child be considered, when the alternative to the risks of HIV is not to be born at all? Does offering ways to reduce risk encourage HIV-infected people to act irresponsibly?
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