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Fertility and HIV
Fertility and HIV

and HIV

Treatment in HIV serodiscordant couples

Today, infection by the Human Immunodeficiency Virus (HIV) is a universal epidemic and its main modes of transmission is sexually and perinatal (from mother to child during pregnancy). Advances in HIV treatment have allowed improving life quality and expectation of patients.

When steady partners, with one or both of its members infected, decide having a baby, the family doctor acquires a significant role: provide qualified information so the couple can make appropriate decisions. In these cases, contraposition between safe sex and conception makes that real challenges for the healthcare team are considered. Academic and ethical recommendations related to fertility treatments for these type of patients are not well defined.

Since the first HIV identification, it is known that is present as a free virus particles and within the cell pool of genital discharges. Its presence within these fluids is intermittent and not related to the disease stage or quantity of viral load in the plasma (HIV quantity within blood). Even though some reports mention the presence of HIV particles in the sperm, to the date, there is no conclusive evidence demonstrating that this cell is infectious.

From 1989, medical researches with artificial insemination experience in discordant couples (infected male – non-infected female) began to appear. The procedures performed, which consist on centrifuge, washing and gradient separation processes (Swim-up, Percoll, etc.), separate cells and free viruses from sperms.

Gynecologic teams with assisted reproduction experience began to offer to discordant couples (HIV(+) male and HIV(-) female), this therapeutic option with encouraging results. To the date, infection cases from mothers to children related to this procedure have not been reported.

In the assistance performance, patients –carriers of this infection have brought up the advice in relation to procreation possibilities. This situation has encouraged the creation of multidisciplinary teams, comprised by general practitioners, infectologists specialized HIV infection, and gynecologists specialized in assisted reproduction to provide a proper alternative that allows a conception possibility by decreasing an infection possibility.

In cases where the woman is infected with the virus and the man is not, there are also treatment possibilities, but first an effective antiviral treatment should be applied to decrease the viral load at the minimum, since in these cases the main risk is the “vertical” transmission (from mother to child) during pregnancy. With the current treatments, this probability is lower than 1% by which today it is possible to be able to enjoy maternity, as long as the mother is perfectly and previously controlled and treated.

When both partners of a couple are infected, the current infectoligists’ recommendation is to keep protected intercourse since there is the possibility that both partners are infected with different HIV subtypes. Therefore, in many of these cases, it may be necessary to turn to the assisted reproduction.

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