New ethics guidelines for HIV patients

Posted 8:13AM on Wednesday 13th February 2002 ( 23 years ago )

WASHINGTON - Fertility specialists shouldn't dismiss the idea of helping some HIV-infected parents have children, new ethics guidelines say. The standards issued Wednesday by the American Society for Reproductive Medicine say therapies now exist that can greatly reduce the risk of passing HIV, the virus that causes AIDS, to the baby. They do not encourage HIV-infected couples to have children and caution that doctors should ensure parents understand their baby could be infected, regardless of what precautions are taken. Since 1994, the group's ethics guidelines have discouraged fertility treatment if a potential parent has HIV. The risks of infecting the unborn child were too great. Today's therapies allow many HIV patients to live longer, healthier lives, and most patients are in their prime childbearing years. Special prenatal care can greatly reduce - although not eliminate - the risk of infecting a baby, the society's ethics committee concluded. An estimated 200 to 300 infants are born with HIV each year, most thought to have been born to mothers improperly tested or treated for HIV, says the federal Centers for Disease Control and Prevention. The CDC doesn't say HIV patients should never have children. But ``they shouldn't attempt it on their own,'' stressed Dr. Robert Janssen, the CDC's HIV chief. ``There is always going to be a risk'' of passing the deadly virus to the baby, he said. But working with a fertility specialist skilled in HIV can ``reduce the risk of transmission to the lowest possible level.'' Art Caplan, a bioethicist at the University of Pennsylvania, said the moral implications of HIV-positive parents having children are shifting because of medical advances. ``Morally, I always have a problem if you are creating orphans, but AIDS is slowly moving from a terminal illness to a chronic one,'' Caplan said. ``The new facts demand new thinking. The reality is that you are not condemning a child to permanent illness or death.'' HIV patients' desire to conceive is ``a very difficult decision,'' said AIDS Action director Marsha Martin. She applauded the new guidelines. ``It at least helps people feel they can walk into the fertility clinics and have a conversation. It encourages the physicians to open up and be available to people living with HIV.'' The fertility society's new guidelines say: - Appropriate drug therapy, a Caesarean section and no breast-feeding drops an HIV-positive pregnant woman's chances of infecting her baby from 20 percent down to about 2 percent - but the risk isn't zero. - If only the potential father has HIV, both mother and fetus could be infected. Unprotected intercourse is not safe. Special sperm washing and testing before artificial insemination appears to greatly reduce risk, but more proof is needed. Couples should be counseled about considering donor sperm, adoption or not having children. - If both potential parents have HIV, they must be counseled about the risk of infecting and orphaning a baby. Many couples at risk for genetic diseases such as cystic fibrosis attempt conception despite a 25 percent chance of having an ill child, the guidelines note. Fertility specialists who treat those couples also ``should find it ethically acceptable to treat HIV-positive individuals or couples who are willing to take reasonable steps to minimize the risks of transmission,'' they say.

http://accesswdun.com/article/2002/2/203062