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Hum. Reprod. Advance Access originally published online on July 19, 2007
Human Reproduction 2007 22(9):2353-2358; doi:10.1093/humrep/dem226
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© The Author 2007. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

NEW DEBATE

Is natural conception a valid option for HIV-serodiscordant couples?

Pablo Barreiro1,3, José Antonio Castilla2, Pablo Labarga1 and Vincent Soriano1

1 Department of Infectious Diseases, Hospital Carlos III, Calle Sinesio Delgado 10, 28029 Madrid, Spain 2 Reproduction Unit, Hospital Virgen de las Nieves, Granada, Spain

3 Correspondence address. Tel: +34 914 53 2781; Fax: +34 917 33 6614; E-mail: pm.barreiro{at}gmail.com

The remarkable reduction in HIV-related morbidity and mortality as a consequence of the widespread use of highly active antiretroviral therapy (HAART) has led to a growing number of HIV-infected persons and their partners requesting counselling regarding the chances of reproduction. A thoughtful medical evaluation of the couple, which should entail HIV status, screening for genital infections and fertile potential, is needed before considering any reproductive attempt. Given that both sexual and perinatal transmission of HIV is directly correlated with the level of viral replication, being almost negligible in patients with undetectable viremia, HAART should be given to the infected partner to minimize the risk of transmission. Assisted reproduction after ‘sperm washing' may further reduce the chances of infection, although this is not within reach or desire for a significant number of HIV-serodiscordant couples. From our perspective, natural conception could now be considered a possible alternative for HIV-serodiscordant couples, as long as complete suppression of viremia with HAART is achieved in the infected partner. The objective of this paper is to propose a protocol that may minimize risks in HIV-discordant couples that have opted for natural conception.

Key words: HIV/sexual transmission/vertical transmission/antiretroviral therapy/viral load

Submitted on February 3, 2007; resubmitted on June 1, 2007; accepted on June 21, 2007.


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