Natural Conception is Safe for HIV-Serodiscordant Couples with Persistent Suppressive Antiretroviral Therapy for the Infected Partner
Publication: Journal of Women's Health
Volume 28, Issue Number 11
Abstract
Background: Sustained use of antiretroviral treatment to achieve a suppressed viral load in persons living with HIV is associated with zero or near-zero risk of sexual and vertical HIV transmission. This has led to an increasing number of HIV-serodiscordant couples (SDCs) who wish to have children. The aim of this study was to describe the most recent results of a protocol for reproductive counseling directed at HIV-SDCs who desire natural conception and to identify some of the factors influencing reproductive success.
Methods: Two hundred fourteen couples were enrolled. Sociodemographic/behavioral and clinical data were collected. CD4+ lymphocyte count, HIV viral load, serology/viral load of hepatitis B/C viruses, syphilis serology, and other sexually transmitted infection diagnosis in both members of couple; spermiogram in men, HIV proviral and viral load in semen of male HIV-infected partners, and urine luteinizing hormone qualitative test in women were performed. Unprotected vaginal intercourses, pregnancies achieved, and their outcomes were recorded.
Results: After almost 10,000 sexual relations, a total of 188 pregnancies was achieved, 62% of couples became pregnant once or several times with no HIV transmission to either the partner or the offspring. Younger age of woman, no fertility disorders in both members of couple, and no treatment with efavirenz in men were factors related with reproductive success.
Conclusions: Natural conception, under controlled conditions, can be offered to SDCs who wish to have children as a safe method of conception and its effectiveness seems to be related to factors not different from those of the general population.
Get full access to this article
View all available purchase options and get full access to this article.
References
1. Del Romero J, Castilla J, Hernando V, Rodríguez C, García S. Combined antiretroviral treatment and heterosexual transmission of HIV-1: Cross sectional and prospective cohort study. BMJ 2010;340:c2205.
2. Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med 2011;365:493–505.
3. Mandelbrot L, Tubiana R, Le Chenadec J, et al. No perinatal HIV-1 transmission from women with effective antiretroviral therapy starting before conception. Clin Infect Dis 2015;61:1715–1725.
4. Del Romero J, Baza MB, Río I, et al. Natural conception in HIV-serodiscordant couples with the infected partner in suppressive antiretroviral therapy. A prospective cohort study. Medicine 2016;95:e4398.
5. Vernazza PL, Graf I, Sonnenberg-Schwan U, et al. Preexposure prophylaxis and timed intercourse for HIV-discordant couples willing to conceive a child. AIDS 2011;25:2005–2008.
6. Baeten JM, Donnell D, Ndase P, et al. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med 2012;367:399–410.
7. Whetham J, Taylor S, Charlwood L, et al. Pre-exposure prophylaxis for conception (PrEP-C) as a risk reduction strategy in HIV-positive men and HIV-negative women in the UK. AIDS Care 2014;26:332–336.
8. Sun L, Wang F, Liu A, et al. Natural conception may be an acceptable option in HIV-serodiscordant couples in resource limited settings. PLoS One 2015;10:e0142085.
9. Baggaley RF, White RG, Hollingsworth TD, et al. Heterosexual HIV-1 infectiousness and antiretroviral use: Systematic review of prospective studies of discordant couples. Epidemiology 2013;24:110–121.
10. World Health Organization. WHO laboratory manual for the examination of human semen and sperm-cervical mucus interaction, 4th ed. Cambridge, United Kingdom: Cambridge University Press, 1999.
11. World Health Organization. WHO laboratory manual for the examination and processing of human semen, 5th ed. Geneva, Switzerland: WHO, 2010.
12. World Health Organization. WHO recommendations on the diagnosis of HIV infection in infants and children. Geneva, Switzerland: WHO, 2010.
13. Rodger AJ, Cambiano V, Bruun T, et al. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. JAMA 2016;316:171–181.
14. Pollock LC, Weber S, Kaida A, Matthews LT, Seidman DL. HIV-affected couples and individuals who desire children should be offered options for safer conception. J Int AIDS Soc 2017;20:22155.
15. Mandelbrot L, Berrebi A, Rouzioux C, et al. [Reproductive options for people living with HIV: 2013 guidelines from the French expert working group]. Gynecol Obstet Fertil 2014;42:543–550 (Article in French).
16. Hoffman RM, Jaycocks A, Vardavas R, et al. Benefits of PrEP as an adjunctive method of HIV prevention during attempted conception between HIV-uninfected women and HIV-infected male partners. J Infect Dis 2015;212:1534–1543.
17. Zafer M, Horvath H, Mmeje O, et al. Effectiveness of semen washing to prevent human immunodeficiency virus (HIV) transmission and assist pregnancy in HIV-discordant couples: A systematic review and meta-analysis. Fertil Steril 2016;105:645.e2–655.e2.
18. Bujan L, Hollander L, Coudert M, et al. Safety and efficacy of sperm washing in HIV-1-serodiscordant couples where the male is infected: Results from the European CREAThE network. AIDS 2007;21:1909–1914.
19. Panel on Antiretroviral Guidelines for Adults and Adolescent. Guidelines for the use of antiretroviral agents in adults and adolescents living with HIV. Department of Health and Human Services. Available at: http://aidsinfo.nih.gov/ContentFilesAdultandAdolescentGL.pdf Last updated October 25, 2018.
20. Steiner AZ, Jukic AMZ. The impact of female age and nulligravidity on fecundity in an older reproductive age cohort. Fertil Steril 2016;105:1584–1588.
21. Esteves S. Novel concepts in male factor infertility: Clinical and laboratory perspectives. J Assist Reprod Genet 2016;33:1319–1335.
22. Lambert-Niclot S, Poirot C, Tubiana R, et al. Effect of antiretroviral drugs on the quality of semen. J Med Virol 2011;83:1391–1394.
23. Frapsauce C, Grabar S, Leruez-ville M, et al. Impaired sperm motility in HIV-infected men: An unexpected adverse effect of efavirenz. Hum Reprod 2015;30:1797–1806.
24. Jerónimo A, Baza MB, Río I, et al. Factors associated with seminal impairment in HIV-infected men under antiretroviral therapy. Hum Reprod 2017;32:265–271.
25. Giakoumelou S, Wheelhouse N, Cuschieri K, Entrican G, Howie SEM, Horne AW. The role of infection in miscarriage. Hum Reprod Update 2016;22:116–133.
26. Gingelmaier A, Wiedenmann K, Sovric M, et al. Consultations of HIV-infected women who wish to become pregnant. Arch Gynecol Obstet 2011;283:893–898.
27. Finocchario-Kessler S, Goggin K, Staggs V, et al. High report of miscarriage among women with HIV who want to conceive in Uganda. BMC Res Notes 2018,11:753.
28. Massad LS, Springer G, Jacobson L, et al. Pregnancy rates and predictors of conception, miscarriage and abortion in US women with HIV. AIDS 2004;18:281–286.
29. Safier LZ, Sauer MV. Fertility care interventions should be provided as the first line options for HIV+ serodiscordant couples who desire children in settings with affordable access to care, regardless of their fertility status. J Int AIDS Soc 2017;20:21294.
30. Bujan L, Pasquier C. People living with HIV and procreation: 30 years of progress from prohibition to freedom? Hum Reprod 2016;31:918–925.
Information & Authors
Information
Published In
Journal of Women's Health
Volume 28 • Issue Number 11 • November 2019
Pages: 1555 - 1562
PubMed: 31329519
Copyright
Copyright 2019, Mary Ann Liebert, Inc., publishers.
History
Published online: 12 November 2019
Published in print: November 2019
Published ahead of print: 22 July 2019
Topics
Authors
Author Disclosure Statement
No competing financial interests exist.
Metrics & Citations
Metrics
Citations
Export Citation
Export citation
Select the format you want to export the citations of this publication.
View Options
Get Access
Access content
To read the fulltext, please use one of the options below to sign in or purchase access.⚠ Society Access
If you are a member of a society that has access to this content please log in via your society website and then return to this publication.