A Cure That Asks More Questions

I was in college and we sat in a lounge somewhere on campus after closing our books for the night. Jon told us his mother had called earlier in the day. In a southern drawl he related her words: “Jon, you’re an uncle.”

He accepted our congratulations with a smile but confessed that he hadn’t known his sister was even pregnant and to our mixed disbelief and surprise told us that his sister hadn’t known either.  He added that she was quite overweight and had presumed a little more weight gain and some flutterings in her abdomen were due to indiscretion, nothing more.

I thought of this the other day when I read about the possible cure of an HIV-positive baby.  While the case raises more questions than it answers in terms of HIV – should every HIV-positive newborn receive triple drug therapy? Is this infant really cured? Was in utero versus intrapartum transmission a factor in the infant’s infection and if so is it a factor in the child’s response to treatment? Were the drugs used particularly effective for an infection in a neonate? The questions go on.  But what struck me about this case was the information that the woman presented to have her baby not knowing that she was HIV-positive and not having received any prenatal care.  How does it happen in our country that a woman gets pregnant, carries a pregnancy to term and delivers the child without receiving any prenatal care?

In fact, the CDC reported in 2010 that over 47,000 of the 4 million births in the United States were to women who had received no prenatal care.

There are several reasons but none of them feel right.  The woman may not have had access to care; she may live far from any obstetrical clinic or she may not have the financial resources, insurance or benefits to obtain that care.  She may be in denial about the pregnancy.  She may be cognitively challenged or not realize what is happening to her or if she realizes, she may lack the knowledge or understanding of how to deal with it.  It’s possible that she’s obese and like Jon’s sister she might be oblivious to the bodily changes that occur in pregnancy because her weight so distorts her self-image.  Lack of prenatal care correlates with lower socio-economic status and poor education in the mother.  And as such doesn’t bode well for the child born of that mother.  Mothers and their babies who receive no prenatal care are at risk for any number of short and long term complications, including death.  It seems wrong and sad that a baby should be born without its mother receiving care for her pregnancy.

For this one baby, however, regardless of its mother’s circumstances, the fact that her HIV was undiagnosed means that the child’s HIV was not prevented – with standard medications offered at the time of delivery and post-partum.  So in this case the child was started on medication for treatment, not prevention.  And while it is disturbing to think of any woman in the United States going without prenatal care, this one child may lead us to a significant finding in the treatment of HIV.