Many HIV-discordant couples express a strong wish to conceive a child. Insemination with processed semen is offered to these couples in many countries. Given the very low level of transmission risk during fully suppressive antiretroviral therapy, we offered timed intercourse combined with preexposure prophylaxis to further reduce the transmission risk. In 53 cases, natural conception was attempted using the proposed method. Pregnancy rates were high and reached a plateau of 75% after six cycles. Advanced age in the female partner was a predictor for infertility in these couples.

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Preexposure prophylaxis and timed intercourse for HIV-discordant couples willing to conceive a child.

Top of page
Abstract
Introduction
1.0 Summary of recommendations
2.0 Scenarios: interventions to reduce mother-to child transmission of HIV
3.0 Background: UK prevalence of HIV in pregnancy and risk of transmission
4.0 Antenatal HIV testing
5.0 Preconception and fertility management in men and women infected with HIV
6.0 Sexual health of HIV-positive pregnant women
7.0 Psychosocial issues
8.0 Viral load and resistance
9.0 Management of HIV-related complications in pregnancy
10.0 Antiretroviral therapy in pregnancy: efficacy
11.0 Antiretroviral therapy in pregnancy: toxicity
12.0 Antiretroviral therapy and pregnancy: pharmacokinetics
13.0 Obstetric management of pregnancy and delivery
14.0 Pregnancy in women with HIV-2 infection
15.0 HIV and hepatitis B and C coinfections
16.0 Management of infants born to HIV-infected mothers
17.0 Infant feeding and HIV transmission during breastfeeding
References
Appendix

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British HIV Association and Children's HIV Association guidelines for the management of HIV infection in pregnant women 2008

Five percent of 145 HIV-1 infected men enrolled in an assisted reproductive technology (ART) program harbored detectable HIV-1 RNA in semen, although they had no other sexually transmitted disease and their blood viral load was undetectable for at least 6 months under antiretroviral treatment. This result justifies measuring HIV-1 RNA in semen before the ART process and suggests that a residual risk of transmission has to be mentioned to the patients who would like to have unprotected sexual intercourse.

Detection of HIV-1 RNA in seminal plasma samples from treated patients with undetectable HIV-1 RNA in blood plasma.

A Fakoya, H Lamba, N Mackie, R Nandwani, A Brown, EJ Bernard, C Gilling-Smith, C Lacey, L Sherr, P Claydon, S Wallage and B Gazzard British HIV Association (BHIVA), BHIVA Secretariat, Mediscript Ltd, 1 Mountview Court, 310 Friern Barnet Lane, London N20 OLD, British Association for Sexual Health and HIV (BASHH), Royal Society of Medicine, 1 Wimpole Street, London W1G OAE and Faculty of Sexual and Reproductive Health of the Royal College of Obstetricians and Gynaecologists (FSRH), 27 Sussex Place, Regent’s Park, London NW1 4RG, UK

/pdf/british-hiv-association-bashh-and-fsrh-guidelines-for-the-3aiqz8pw8p.pdf

British HIV Association, BASHH and FSRH guidelines for the management of the sexual and reproductive health of people living with HIV infection 2008

Achieving safe conception in HIV-discordant couples: the potential role of oral preexposure prophylaxis (PrEP) in the United States.

Objective: To examine the safety and effectiveness of assisted reproduction using sperm washing for HIV-1-serodiscordant couples wishing to procreate where the male partner is infected. Design and methods: A retrospective multicentre study at eight centres adhering on the European network CREAThE and involving 1036 serodiscordant couples wishing to procreate. Sperm washing was used to obtain motile spermatozoa for 3390 assisted reproduction cycles (2840 intrauterine inseminations, 107 in-vitro fertilizations, 394 intra-cytoplasmic sperm injections and 49 frozen embryo transfers). An HIV test was performed in female partners at least 6 months after assisted reproduction attempt. The outcome measures recorded were number of assisted reproduction cycles, pregnancy outcome and HIV test on women post-treatment. Results: A total of 580 pregnancies were obtained from 3315 cycles. Pregnancy outcome was unknown in 47 cases. The 533 pregnancies resulted in 410 deliveries and 463 live births. The result of female HIV testing after assisted reproduction was known in 967 out of 1036 woman (7.1% lost to follow-up). All tests recorded were negative. The calculated probability of contamination was equal to zero (95% confidence interval, 0‐0.09%). Conclusion: This first multicentre retrospective study of assisted reproduction following sperm washing demonstrates the method to be effective and to significantly reduce HIV1 transmission risk to the uninfected female partner. These results support the view that assisted reproduction with sperm washing could not be denied to serodiscordant couples in developed countries and, where possible, could perhaps be integrated into a global public health initiative against HIV in developing countries.

Alexandra Vucetich

Papers

Safety and efficacy of sperm washing in HIV-1-serodiscordant couples where the male is infected: results from the European CREAThE network.