THURSDAY, Feb. 27, 2003 (HealthDayNews) -- Babies who were infected with HIV while still in their mother's womb are now growing up and having babies of their own.
But the new mothers are not necessarily passing on the virus that causes AIDS.
When the Centers for Disease Control and Prevention looked at a small group of girls and young women who have been HIV-positive all their lives and who now have babies, they found that not one of the new generation of children was infected with HIV.
"It's a testimony to how successful treatment during pregnancy is," says Dr. Mary McConnell, of the CDC's division of HIV/AIDS.
This report, appearing in the Feb. 28 issue of the CDC's Morbidity and Mortality Weekly Report, is the first to describe pregnancies in adolescent and young-adult women who were perinatally infected with HIV (perinatally means infected at or before the time of birth).
Although this is the first report, the eight females in the study are probably not the only ones in their group to get pregnant. "It's happening. There are others around the country," McConnell says.
Children who were unlucky enough to be born HIV-positive before the advent of potent antiretroviral (ARV) therapy in the mid-1990s often died before reaching sexual maturity. Since that time, however, the life expectancy for all HIV-positive people has increased substantially.
And, as this small study attests, not only are individuals surviving, they're becoming sexually active and mothering babies as well. In fact, their behavior might not differ significantly from that of non-HIV infected young people. The phenomenon underscores the importance of tailoring services and strategies to this group of girls and young women, the CDC points out.
Between August 1998 and May 2002, the Puerto Rico Department of Health identified a total of 10 pregnancies among eight perinatally HIV-infected adolescents and young women in four cities on the island. In April 2002, the Puerto Rican health officials asked the CDC to help assess the phenomenon. The current report is the result of that effort.
The eight young mothers were compared to eight females who were also HIV-positive but who had not been pregnant.
The females in the pregnancy group had a mean age of 18 (the range was 15 to 22) and had been a median age of 17 (range 13 to 19 years) when they first became pregnant. Seven pregnancies produced seven live infants. Two pregnancies ended in abortion and one in a miscarriage. McConnell says that only one of the female's partners is HIV-positive.
Five of the eight reported that their pregnancies had been intended, and two said that they had used condoms (unsuccessfully) for birth control.
The majority of patients had ARV therapy while they were pregnant, and all the infants received the drug zidovudine as a preventive measure after they were born.
There were some differences between the pregnancy group and the control group. For one thing, only two individuals in the control group reported being sexually active. In addition, more of the females in the pregnancy group had dropped out of school before getting pregnant and had friends who had become pregnant before they did. The controls were also older (median age of 17) when they had their first sexual encounter than the women in the pregnancy group (median age of 15).
Individuals in the control group were also diagnosed with HIV earlier (at a median age of 4 vs. 7) and learned of their status earlier (at a median age of 12 years versus 13 years). This suggests that informing a child or adolescent of their HIV status earlier might guard against teen pregnancies.
A more productive comparison may have been between HIV-positive women who are pregnant or mothers and HIV-negative women who are pregnant or mothers, says Naomi Rutenberg, senior program associate at the Population Council in Washington, D.C. Such a comparison might shed light on "differences in information and support those two groups are receiving to help make informed decisions about childbearing," she says.
But the CDC findings do point up some possible areas to work on.
"At least in Puerto Rico, providers are working on disclosing earlier their HIV status and to work with families on earlier disclosures," McConnell confirms.
Age at disclosure is an area of active debate in general, McConnell adds. "It's certainly something that's being looked at as this population gets older and older," she says. "There are a couple of articles in press right now that have more systematically looked at the most effective balance between appropriately telling them their status but acknowledging it's a burden to know as well. People are reluctant to do it too young."
One point not mentioned is the implications of an HIV-positive mother raising children. "There's a debate about the prospects of the child because of the mother's heightened risk of mortality," Rutenberg says. "The mother's viral counts were OK, but they weren't fantastic."
All of this conjecture is a luxury restricted primarily to the developed world. Elsewhere, fewer kids are surviving to adolescence and, when they do, not much is known about them, Rutenberg points out.
More information
Learn about mother-to-baby transmission of HIV and how to prevent it from Women Alive or AIDS Map.
