HIV Prevention Among HIV-Discordant Couples Trying to Conceive
According to the Centers for Disease Control and Prevention (CDC), the estimated number of HIV infections and incidence rate each year has decreased from 2010 to 2014 in the United States. The survival rate is also increasing due to effective highly active antiretroviral therapy (HAART).
Many individuals infected with HIV or those in discordant relationships—where one member is infected and one is not—may want to conceive and have their own biological children. For discordant couples where the female partner is HIV-infected and the male partner is not, autologous sperm intrauterine insemination may help achieve conception without placing the male partner at risk for infection.
But for couples where the male partner is HIV-infected and the female partner is not, methods for minimizing the risk for sexual transmission are necessary. The CDC recommended against insemination with semen from HIV-infected men in 1988. Since then, new data has been published about preventing HIV transmission in discordant couples.
A review of recent data showed that insemination with sperm from an HIV-negative donor is the safest option for a discordant couple where the woman does not have HIV but the man is HIV-positive. Strategies to reduce risk by using sperm from an HIV-positive male partner are also discussed. One approach is taking HAART to achieve viral suppression in the male partner in addition to intercourse without condom protection around the time of ovulation where the female is taking daily oral pre-exposure prophylaxis (PrEP). For males on HAART with undetectable plasma and seminal viral loads, the postulated transmission risk to a female partner during intercourse without condom protection is deemed low (0.16 per 10,000 exposures, 95% CI: 0.02–1.3).
Another potential method, to be combined with HAART and PrEP, is sperm washing where HIV-infected cells are removed, the sperm is tested to verify no HIV presence and then used for intrauterine insemination (IUI) of the female partner or for in vitro fertilization (IVF). Recent evidence suggests that newer methods of sperm washing can be highly effective; in about 11,500 assisted conception (IUI and IVF) cycles in HIV-uninfected women using sperm from HIV-infected partners after sperm washing, 0 HIV transmissions were reported to the women or resultant offspring.
The researchers state, "Each method has a unique risk profile, might confer distinctive advantages and disadvantages, and requires varying degrees of assistance from the medical community." Discordant couples attempting to conceive should discuss the risks and benefits of each strategy with an experienced healthcare provider.
For more information visit CDC.gov.