Conception Strategies and Care for Persons of Childbearing Age with HIV
SUMMARY:
There are strategies for couples who want to conceive when one or both partners have HIV. Thanks to highly active antiretroviral therapy (HAART), men and women are living longer, with better quality of life and may wish to have their own biologic children. The safest option remains sperm insemination from an HIV-negative donor. However, if donor sperm is not an acceptable option, the CDC presents the following risk reducing approaches for consideration:
- Expert consultation recommended to tailor guidance
- Partner with HIV: Should achieve sustained viral suppression (e.g. two recorded measurements of undetectable viral loads ≥ 3 months apart)
- If partner with HIV has sustained viral suppression very low risk of transmission of HIV to partner
- Option for daily oral antiretroviral preexposure prophylaxis (PrEP) while attempting conception, starting 20 days prior to exposure and for 28 days after last vaginal exposure
- Consider PrEP if HIV partner has not achieved sustained viral suppression, or if concerned about inconsistent HAART adherence
- Both partners should be screened for STIs
- Time condomless sex to coincide with ovulation
- Referral to fertility specialist if no conception by 6 months
Strategy 1: Intercourse without condom limited to ovulation
- Men on HAART with undetectable plasma viral loads might still be at low risk (1.2 per 100 person-years, CI = 0.9–1.7) for transmitting HIV-1 to their female partner through condomless sexual intercourse
Or
Strategy 2: Collection and washing of the male partner’s sperm to remove cells infected with HIV with follow up testing to ensure absence of HIV prior to IUI or IVF
- 1.3%–7.7% of washed specimens may test positive after washing and should be discarded
- Unknown whether there is greater benefit with IVF vs. IUI
- In theory, because IVF is more efficacious compared to IUI, there may be reduced exposure to infected sperm
- Unknown if any difference with ICSI
The authors of the CDC Morbidity and Mortality Weekly Report (MMWR) refer to ACOG and ASRM guidance:
The American College of Obstetricians and Gynecologists, the American Society of Reproductive Medicine, and others have published guidance documents that emphasize the importance of considering HIV a chronic disease or disability, which should not result in discrimination and for which fertility treatment should be offered if it is desired.
