Miracle Moms

By Melba Newsome

In 1994, Kelli Lawless, 24, of O'Fallon, Mo., waited for test results she hoped would solve the mystery of her failing health. For years, she had been plagued by a string of illnesses including sinus infections, pneumonia and two bouts of shingles, but her doctor had never performed a test that would have been routine for someone else with those symptoms. "He said that people like me--a white, middle-class, non-drug-using, college-educated woman in Iowa-- didn't get HIV/AIDS." Alas, in Lawless's case, he was mistaken. Testing showed that she was positive for HIV. "I know this sounds strange, but I was relieved to know what was wrong because I was beginning to feel like I was crazy."

Lawless ultimately traced her infection to someone she had dated during college who had contracted the virus through a blood transfusion. Despite her uncertain future, she and her boyfriend of five years, Jim Hughes, who remained uninfected, decided to marry. But starting a family was not part of the plan for the couple, who practiced safe sex. "I thought HIV was a death sentence, and we weren't even sure I'd make it to the wedding the next year, let alone have children."

As a new generation of drugs began helping people with HIV/AIDS live longer and healthier lives, Kelli and Jim Hughes began to feel more hopeful about the future. During a visit to her doctor, Kelli tentatively broached the subject of having children and was stunned when she received a go-ahead. "We had adjusted to a marriage without kids," says Jim, who grew up with nine siblings and desperately wanted children. "When they said it was O.K., we were shocked because everything we'd heard up to that point was that we couldn't have children because they would be infected." Using home artificial insemination, the Hugheses easily conceived and had a baby boy in 1999. They had a second son last year. Both Jamison, 6, and Donovan, 1, are HIV negative.

Kelli's tale is no longer unusual. According to Dr. Marc Bulterys of the HIV/AIDS division of the Centers for Disease Control and Prevention (CDC) in Atlanta, advances in medicine have made childbearing much safer for the 6,000 to 7,000 HIV-infected women who give birth each year in the U.S. In the mid-1990s, treatments to prevent infant HIV infection were only 60% to 70% effective. Today, when a woman is identified as HIV positive before or very early in pregnancy and is treated appropriately, the risk of her baby's being infected is less than 1%.

As a result, there's been a significant change in the attitude of women with HIV, says Dr. Jaime Deville, assistant professor of pediatrics at the University of California, Los Angeles. "When they begin to understand their illness and learn how to control it, many more are willing to have a family. In fact, we have cases where women have a second, third and even fourth child."

Getting pregnant without infecting a partner is the first obstacle for those women. Some, like Kelli Hughes, use artificial insemination, while others opt to have unprotected sex when their viral load--or measure of the virus in their bloodstream--is low. During the first trimester of pregnancy, the women take a break from any antiretroviral drugs they may have been taking so that the fetus is not exposed during this critical developmental window. But drug treatment is resumed or begun in the second trimester and continued through the end of the pregnancy. At the time of delivery and for six weeks afterward, the newborn is given AZT every six hours. "As long as those procedures are followed, the risk of transmission is very low," says Deville. "In fact, we have not seen a single case of mother-to-child infection."

Although there are as yet no long-term studies of children who have undergone the treatment, the benefits appear to greatly outweigh the risks. According to the CDC, antiretroviral-drug therapy can lead to premature birth or mitochondrial misfunction, a lethal defect, but such problems are extremely rare.

The Hugheses have taken some criticism for their decision to have children when Kelli's life expectancy is uncertain, but they are confident that they have made the right choice. And they are quick to point out that there's no guarantee any mother will be around to see a child grow up.