“We Want to Have a Baby”
In the late 1980s and early ’90s we had a patient – actually, he’s still a patient – who was married and had HIV. We treated him, and he’s done well over the years.
His wife was HIV-negative. At the time, the recommendation to prevent the wife from contracting HIV was to not have sex, or have sex with condoms. In those days, there wasn’t any pre-exposure prevention, or PrEP.
He and his wife did well on that abstain plus condoms thing for quite some time.
From time to time, he would ask, “What if we want to have a baby.”
My answer was always, “This just isn’t the time.” If he stopped using condoms, we thought there would be a chance that his wife would become HIV-positive.
One day he and his wife came in and said, “We want to have a baby” and the tone was different. It was, we're not asking you for permission anymore. We're telling you that this is what we're going to do.
I asked them to give me a week or so to figure this out.
This was late 1992, early 1993. Steve Scheibel had left Community Health Network to practice in California. I called him and asked what we should do.
Dr. Steve Scheibel was always ahead of curve in HIV/AIDS care. Provided by Dr. Bill Valenti
He said it made sense that if you treat the wife with HIV drugs, you’d stand a good chance of preventing HIV in her and preventing HIV in the baby.
But this really wasn't known. That information would come two years later. But as usual, Scheibel was ahead of the curve.
So we put the man’s wife on this regimen of HIV medicine. When they were in the office and getting ready to go, the man had a big smile on his face and I said, “OK, you're good to go. But please, make it snappy. Just do it and get it over with.”
They did.
During her pregnancy, we saw both of them regularly to check on how the drugs were doing and that sort of thing. At the right time, they had a baby who is HIV-negative and the mother remained HIV-negative. A win.
Scheibel and I of course were both delighted at all of this, to say nothing to the parents who had this great little kid.
Now, what happened two years later, which Scheibel predicted, is that if you have an HIV-positive mother, and you give mother HIV drugs during the pregnancy -- those days it was AZT -- and give the baby an injection of AZT at delivery, that child would be HIV-negative.
What we were trying to do in this case was prevent HIV in the mother so that she didn't pass it on to the baby.
The other thing we didn't know at the time was that since he was taking his drugs and doing well, he probably wasn't shedding much virus anyway.
But the whole thing was totally new and there were no answers. It was kind of like building the car as it goes down the highway.
We had some knowledge about AZT use in pregnant women because sometimes HIV-positive women on AZT, or even not on it, got pregnant and then were treated with AZT without any problems in the child.
So the safety issues were in our favor. But that was based on experience, certainly no clinical trials. I remember Scheibel being thoughtful about what to do and explaining what he was thinking along the way to try and get the desired outcome.
And we had two willing participants.
Over the years, the dad would bring the kid to appointments and the kid always had a either a pencil and a paper with him, practicing his numbers or was reading a book. I watched this kid grow up.
And finally, 17 years later, both parents came into the office and said Junior graduated from high school and he has a full scholarship to Columbia University journalism school. We all just laughed and stood up and had a group hug. It was like we were dancing over this remarkable achievement. They did everything they should and more. Geez, we did it. We got this kid into college. Now, he’s 32 years old and he’s a news writer.
I saw the dad a couple of weeks ago and we always talk about, “Remember when you didn’t want us to have a kid?”
I remember it very well. I remember the dread. And I knew they were going to have it, with or without my advice. So we might as well do it right.