nursing and midwifery - text

All couples affected by HIV

Natural conception and treatment

  • Many couples want to conceive naturally and strategies may be used to minimize the risk of transmission to the HIV negative partner. These strategies are based on the evidence that HAART reduces the risk of HIV sexual transmission.  Pre-conceptual counselling is essential for couples considering these strategies and must include all of the available evidence on risk. Information on reducing risk includes:
  • Assessing risk based on viral load and absence of STIs (U=U campaign)
  • Initiation of ARV by HIV positive partner with aim of achieving viral suppression for at least six months prior to conception attempts
  • Timed unprotected intercourse at the time of ovulation only
  • Consideration of Pre Exposure Prophylaxis (PrEP) for the HIV negative partner
  • Advantages: Natural conception, no cost, convenient

 

Assisted reproduction

There is evidence that women with HIV show a higher incidence of fertility disorders, indicating increased demand for reproductive treatments. Women with HIV experience reduced pregnancy rates and higher rates of miscarriage. HIV/AIDS may decrease male and/or female fertility by increased risk of female sterility (associated with coinfection with other STIs) and decreasing production and motility of spermatozoa (male).

  • In case of fertility disorders in the female or male partner or both, several techniques of assisted reproduction (IVF, ICSI) can be applied
  • Data on the success rate of IVF/ICSI (intracytoplasmic sperm injection) in HIV positive women remain unclear, since current case numbers are too low to estimate exact rates

 

Adoption

Adoption or fostering might be another option. Having HIV does not automatically mean someone cannot adopt, but their health and circumstances would be assessed on application, to ensure the child’s long-term needs can be met.

 

Concordant couple

In cases where both partners are HIV-positive, semen processing or donor insemination may also be considered to avoid the risk of HIV superinfection, reinfection and resistance.

 

Related reading

  • In January 2008 the Swiss statement was issued in relation to serodifferent couples who wanted to have a baby. The statement clarifies that very low risk applies to someone who:
    • Has an undetectable viral load for at least 6 months
    • Has excellent adherence to antiretroviral medication
    • Has no other STIs
  • U=U Campaign
  • January 2013 BHIVA and EAGA, 2013 issued a position statement that where one positive partner is taking effective ART, transmission of HIV through vaginal sex is significantly reduced (by 96%)
  • Nice guidelines 156, Feb 2013. Fertility Assessment and treatment for people with fertility problems