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Semen
Washing, Reproductive Technology, Antiretroviral Therapy and Obstetrical
Care Allow Safe Reproduction in HIV Positive Couples
Three
quarters of individuals infected with HIV are in their reproductive
years and can expect an almost normal life expectancy under antiretroviral
treatment. Many of them want to have a child and reproductive counseling
and care can offer a sharp reduction in both sexual and vertical
transmission rates.
Most
couples with HIV are formed by an infected man and an uninfected
woman; in this setting, semen washing coupled with reproductive
technology can be applied to eliminate the risk of sexual transmission
of the virus.
Semen
washing is a processing method which reduces both HIV RNA and DNA
to undetectable amounts. In couples in which only the woman is infected,
self-insemination might be indicated.
When
both partners are carrying HIV, semen washing can be used in couples
with different viral strains.
HIV
can be vertically transmitted and the risk of infection for the
infant can be decreased to approximately 1% by reducing maternal
viral load, elective caesarean section and avoidance of breastfeeding.
In
pregnancy the efficacy of antiretroviral treatment should be balanced
against the possibility of embryonic or fetal toxicity.
Caesarean
section, performed electively, has proven its protective efficacy,
without significant maternal morbidity. Its role should now be reassessed
in mothers with undetectable viral load.
Breastfeeding,
discouraged to avoid postnatal transmission, might be possible in
the future, with antiretroviral therapy capable of suppressing viral
excretion in maternal milk.
In
conclusion, the authors write, “Semen washing, reproductive technology,
antiretroviral therapy and obstetrical care can work in sequence
to allow safe reproduction in couples infected with HIV.”
University of Milan Medical School,
Milan, Italy and University College London, London, UK.
05-12-04
Reference
A
E Semprini and S Fiore. HIV and reproduction. Current Opinions in Obstetrics and
Gynecology 16(3): 257-262. June 2004.
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