Young Women Infected With HIV at Birth Surviving Longer, Becoming Sexually Active, Pregnant, Report Says
The use of highly active antiretroviral therapy is allowing an increasing number of young women who were born with HIV infection to live long enough to become sexually active and become pregnant, according to a report published in today's Morbidity and Mortality Weekly Report, Reuters Health reports. Dr. Michelle McConnell of the CDC and colleagues examined the cases of eight women living in Puerto Rico who contracted HIV from their mothers and who reported 10 pregnancies between August 1998 and May 2002 (McCook, Reuters Health, 2/27). Seven of the pregnancies resulted in live births to six women; two of the pregnancies ended in elective abortion, and one ended in miscarriage. As of Feb. 24, none of the infants had tested HIV-positive (McConnell et al., MMWR, 2/28). All of the infants received antiretroviral therapy following birth, and four of the women consistently took antiretroviral drugs during pregnancy, according to Reuters Health. All of the women became pregnant between 13 and 19 years of age.
During the study, the researchers compared the eight women who had conceived with eight perinatally infected women who had never conceived. Half of the women who had conceived were told of their infection at age 13 or older, whereas half of the women who had not conceived were told of their positive status at age 12 or older. In addition, those who conceived were more likely to be sexually active and less likely to use condoms when having sex; only two of the women who had not conceived said that they were sexually active, and both women reported consistent condom use. However, only two of the eight women who became pregnant reported using condoms (Reuters Health, 2/27). Five of the eight women reported having unintended pregnancies. The median age of first sexual activity among the women who had conceived was 15 years, whereas the median age among the women who had not conceived was 17 years. In addition, women who were told of their infection at an earlier age waited longer to become sexually active (MMWR, 2/28).
"It's a landmark in the HIV epidemic at least in the United States," McConnell said, adding, "Survival has increased to such an extent that not only are (infected babies) surviving but they're healthy enough to get pregnant and have healthy kids" (Simao, Reuters, 2/27). She added, "I think it's going to happen more and more" (Reuters Health, 2/27). As the number of pregnancies among women who were infected perinatally increases, "appropriately tailored reproductive health interventions should be developed," the report states. Of the 16 women surveyed, 10 said that they wanted more information on reproductive health. In addition, the findings suggest that parents of HIV-positive children should disclose their health status to them at an early age and discuss sexual risk reduction. "Providing families with the tools for HIV disclosure to children and for reproductive health discussions before sexual initiation might reduce risky behaviors among these females," the authors write. The authors also note that the findings of the report are "largely descriptive" because of the small sample size, making it difficult to generalize. In addition, matching by age the women who conceived with women who did not conceive may not take into account social or physical development (MMWR, 2/28). The report notes that more study of this small but growing population is needed to better understand primary and secondary mother-to-child HIV transmission and the transmission of drug-resistant HIV strains (Reuters, 2/27). The researchers found drug resistance in all of the women who were tested for genetic mutations. The authors conclude that physicians should report all cases of pregnancy among perinatally infected young women directly to the CDC (MMWR, 2/28).