Your Questions Answered: HIV and Reproduction

By: Jen Sloniger
Your Questions Answered
is a blog series which addresses Project HOPEFUL blog readers’ most burning questions. Please submit your questions to: media@projecthopeful.org

Question: How does HIV affect an adult who is married (and therefore sexually active) to a person who is HIV-? How would the couple go about having a child who is healthy without compromising the health of the spouse who is HIV-?
~Anonymous

ANSWER:
A couple where one partner is HIV+ and the other is negative is called an HIV discordant couple. The good news for discordant couples is that there are options available and child-birthing IS possible for them.

New research shows that early treatment for the HIV-positive partner can reduce transmission between discordant sexual partners 96%

To help us answer today’s questions regarding conception and reproduction our good friend, Linda Walsh, NP, Clinical Director of the University of Chicago Adoption Center shares some information:

To answer the question about conception depends on which partner (woman or man) is infected with HIV as to what strategy will be utilized. Being on a stable ARV regimen, having an undetectable viral load, not having other STDs all decrease the risk of transmission, but do not eliminate it entirely.

There is a technique called sperm washing [for positive men], also artificial insemination is an option [for protection for either a negative man or a negative woman.] And there is some data on doing it the old fashioned way with an undetectable viral load, etc.

Most of my patients, who are young adults/adolescents, have not used the sperm washing technique. All have been young women who’ve had children that are thus far HIV negative. I have no knowledge of any of their partners becoming positive.

Avert.org tells us more about sperm washing:

This involves separating sperm cells from seminal fluid, and then testing these for HIV before artificial insemination or in vitro fertilisation. Sperm washing is a very effective way to protect both the mother and her baby, but it is only available at a few clinics and can be difficult to access, even in well resourced countries.

About.com adds:

Sperm washing is a technique that was first developed in Milan. The concept of sperm washing rests on the premise that HIV resides mainly in the seminal fluid of an HIV positive male. Sperm washing concentrates and separates the fertilizing sperm from the infectious seminal fluid. During ovulation, the woman is then artificially inseminated with the concentrated sperm. Without the infectious seminal fluid, the theory is that the risk of the woman being infected with HIV is greatly reduced, thereby reducing the risk of vertical transmission (transmission from mother to child) as well.In July, 2010 the World Health Organization (WHO) issued new HIV and AIDS guidelines on PMTCT (preventing mother to child transmission) and on HIV and breastfeeding.

According to the 2010 guidelines, all HIV positive mothers, identified during pregnancy, should receive a course of antiretroviral drugs (ARVs) to prevent mother to child transmission. All infants born to HIV positive mothers should also receive a course of ARV drugs and should be exclusively breastfed for 6 months and complementary fed for up to a year.

The risk of transmission from mother to infant without medications is approximately 30%. With PMTCT medical care that number plummets to approximately 1%.

A great resource for learning about comprehensive care is: HIV/AIDS Care and Counseling by Alta van Dyk . You can read the book online HERE

If you’re enjoying this series let us know in the comments below.

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