HIV This Week

Semprini AE, Hollander LH, Vucetich A, Gilling-Smith C. Infertility treatment for HIV-positive women. Womens Health (Lond Engl). 2008;4(4):369-82.

Thanks to antiretroviral combination therapy, HIV-infected individuals live longer, healthier lives and may wish to have children. Women with HIV can attempt to conceive naturally or through simple self-insemination to minimize the risk of horizontal HIV transmission. Assisted reproduction technology is necessary in couples with infertility, which can either be independent of HIV infection and its treatment or be associated with it. This article summarizes the latest evidence regarding the desire for a child in HIV-positive women and how HIV infection and its treatment may impact female fertility. Current data regarding access to and outcomes of assisted conception programs in HIV-positive women wishing to conceive in both high- and low-income countries are also reviewed.

Editors’ note: This exhaustive review covers the evidence that women living with HIV have similar levels of intentions to be a parent as do other women, that pregnancy itself does not worsen the immunological status of HIV-positive women and is not correlated with disease progression, and that HIV-positive women experience increased tubal infertility and reduced ovarian reserve. Limiting unprotected intercourse to the day of ovulation in women who have been screened and treated for sexually transmitted infections can reduce but not eliminate the risk of horizontal transmission to the male partner. The authors favour low-cost, home-based, simple self-insemination which eliminates the risk of HIV transmission to the uninfected male partner. If after 6 cycles of self-insemination with no conception, fertility investigations should begin. Emphasising that leading professional organisations state that assisted reproductive techniques should not be denied HIV-infected couples, the authors conclude with a section on limiting the risks of HIV transmission associated with in vitro fertilisation – intracytoplasmic sperm injection techniques and highlighting the success of sperm-washing programmes in Europe.

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