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Am J Public Health. 2016 Aug;106(8):1390-6. doi: 10.2105/AJPH.2016.303257. Epub 2016 Jun 16.

Ethical and Psychosocial Considerations in Informing HIV-Exposed Uninfected Children That They Were Exposed to HIV and Antiretroviral Medications In Utero.

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Robert Klitzman is with the Masters of Bioethics Program, Columbia University, New York, NY. Claude A. Mellins, Morgan M. Philbin, and Robert H. Remien are with the HIV Center for Clinical and Behavioral Studies and Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, New York, NY. Elaine J. Abrams is with the Mailman School of Public Health, International Center for AIDS Care and Treatment Programs, Columbia University.


We build on what is known about the potential long-term health effects of perinatal antiretroviral medication exposure to examine ethical and psychosocial issues associated with disclosure by applying lessons from other health conditions, theories of child and adolescent development and rights, and the relevant literature and legal contexts. We present 2 cases to highlight potential issues; apply a bioethical framework that includes principles of autonomy, beneficence, nonmaleficence, and justice; and explore other factors, including the current uncertainty about these exposures' possible long-term health risks. This ethical framework can help clinicians and researchers consider and balance relevant concerns in deciding whether to inform offspring of HIV and related exposures.

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