When HIV-discordant couples wish to conceive, several strategies can effectively prevent men from infecting their female partners, according to an analysis in Morbidity and Mortality Weekly Report.
Using sperm from an HIV-negative donor remains the safest choice, but current methods of sperm washing make in vitro fertilization (IVF) or intrauterine insemination (IUI) a low-risk alternative, especially when used together with highly active antiretroviral therapy (HAART) and preexposure prophylaxis (PrEP), wrote Jennifer F. Kawwass, MD, and her associates in the division of reproductive health at the Centers for Disease Control and Prevention, Atlanta (MMWR Morb Mortal Wkly Rep. 2017;66:554-7).
Previously, the CDC recommended against insemination with semen from HIV-infected men. The new report reverses that position, citing epidemiologic and laboratory evidence that conception can occur safely when HIV-discordant couples use combined strategies including HAART, PrEP, and either condomless intercourse limited to the time around ovulation, or sperm washing prior to IVF or IUI.
Sperm washing has been around for about 2 decades, but current techniques appear to significantly cut the risk of HIV transmission, based on epidemiologic data. Among 11,500 IVF or IUI cycles in which uninfected females used washed sperm from their HIV-infected male partners, there have been no cases of HIV transmission to women or their children, the CDC authors emphasized. The use of HAART and PrEP can add an extra layer of protection, they added.
Serodiscordant couples may also consider or prefer natural conception. An HIV-infected male on HAART whose plasma viral load is undetectable can expect to infect his female partner only about 0.16 times for every 10,000 exposures during condomless intercourse, the report noted. Limiting condomless intercourse to the time of ovulation and using PrEP by the uninfected female can further minimize the risk of sexual transmission, the authors added. Experienced medical providers can help HIV-discordant couples further evaluate the “unique risk profile” of each approach to conception, they concluded.
Dr. Kawwass and her associates had no conflicts of interest.