Women Now Look Beyond HIV, to Children and Grandchildren

A few years ago it was almost unheard of for a woman who knew she was infected with HIV to attempt to become pregnant. Most women who knew they were HIV-positive were not willing to risk the 25 percent chance that they would have a child infected with the virus. But now, with a regimen of medication, an HIV-positive woman can reduce the chance of infecting her child to almost zero. Armed with this information, small but increasing numbers of HIV-positive women are deciding to have children.

Experts say the reduction in mother-to-child transmission is one of the few success stories in the 20-year history of AIDS in America. "As far as perinatal transmission, there has been a remarkable change over the last decade," said Dr. Howard Minkoff, chair of obstetrics and gynecology at Maimonides Medical Center in Brooklyn. "Overall, the risk of an American woman having a child with a major birth defect is 2 to 3 percent. In comparison, an HIV-infected woman who does everything right can be reasonably sure that there is a 99 percent chance that her baby will be born free of the virus." The CDC estimates that every year 6,000 HIV-infected women give birth in the United States, and most are on some kind of antiretroviral therapy. In the era before medication was recommended for pregnant HIV-infected women, 1,000 to 2,000 babies were born with the virus each year. Since 1992, there has been a vast decrease in children born with HIV. Now about 300 to 400 HIV-infected babies are born each year.

Despite the improved outlook, researchers remain troubled by the possibility of long-term effects from very potent medication on both mother and child. "None of the drugs are nontoxic," said Dr. Lynne M. Mofenson, associate branch chief for clinical research at the Pediatric, Adolescent and Maternal AIDS Branch of the National Institutes of Health. "These findings should not deter women from taking the medication, but it's very important to acknowledge that babies need follow-up long-term to monitor any potential effects in the future."

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