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Pregnancy, Parenting, and HIV

IMAGE Either you or your partner has tested positive for HIV. Now you want to become pregnant. Is it an impossible dream?
Many people with the HIV virus are living longer and living healthier, and the number of deaths from AIDS has decreased. With a more hopeful future, it is no wonder that people with HIV are wondering about the possibility of pregnancy.
The decision to pursue parenthood is a complicated and difficult one for many people with HIV. High-tech procedures minimize the danger of passing the virus on to a partner or fetus. But no matter which technique is used to achieve pregnancy, there is a chance the child can become infected.
There are other factors to consider, as well. Will the HIV-positive parent live long enough to raise the child? Will the child's quality of life be compromised by the parent's illness? Can the parents designate a guardian? Parents who have HIV must have the courage to face tough decisions about the future, including their own mortality.
People with HIV who wish to conceive a child can start by doing the following:
  • Discussing options with healthcare providers, including ones who have experience with HIV and pregnancy
  • Talking to other couples who have been in the same situation, including parents of HIV-positive children
  • Exploring guardianship with family and friends
Conception techniques, risks, and possibilities differ according to which partner has HIV.

He's Positive, She's Negative

Conception when a man is HIV-positive is tricky, since logic dictates that he must use a condom to protect his partner from becoming infected.
A relatively simple procedure called sperm washing may provide a low-risk conception option that involves artificial insemination with the man’s sperm. For years, this method has been used in sperm banks and infertility clinics to boost sperm potency. Scientists studying the technique have found that it lowers the level of HIV in the semen. The procedure is believed to be effective for reducing infection rates, but it does not completely eliminate the virus. Sperm washing for HIV-positive men is not widely available.
The US Centers for Disease Control and Prevention (CDC) continues to investigate sperm washing. Currently, it does not endorse the practice because its effect cannot be predicted.
You can also consider artificial insemination using donor sperm from a sperm bank. Donor sperm is automatically tested for HIV and cannot be kept if it is positive.

She's Positive, He's Negative

Artificial insemination is an option for a couple in which the woman is HIV-positive. This process puts the man's semen directly into the woman's genital tract so that she can conceive without exposing the man to the virus.
Doctors treat pregnant HIV-positive women with various medications, which can reduce mother-to-baby infection rates to less than 2%. Delivering via Cesarean section might lower the risk even more under certain circumstances. There is additional protection by not breastfeeding and treating the infant with medications after birth.
Factors contributing to the likelihood of a HIV-positive mother passing the infection to her child include:
  • The stage of HIV that the mother is in
  • Whether the mother is taking medications for HIV and how well she has responded to treatment

When Both Prospective Parents Are Positive

People may believe that if both partners have HIV, then they do not need to worry about infecting each other. Right? Wrong.
There are different strains of the virus, some of which are more aggressive. One parent may have one strain, and the other may have a different strain. There are tests that can determine the strain. Once that is known, proper steps can be taken to help reduce the risk of passing different strains between partners.

Difficult Decisions

If you or your partner has HIV, find out your risks and what you can do to minimize them.

RESOURCES

Centers for Disease Control and Prevention http://www.cdc.gov

Family Doctor—American Academy of Family Physicians http://familydoctor.org

CANADIAN RESOURCES

Canadian AIDS Society http://www.cdnaids.ca

The Society of Obstetricians and Gynaecologists of Canada http://sogc.org

References

Having children. US Department of Health and Human Services AIDS website. Available at: http://www.aids.gov/hiv-aids-basics/staying-healthy-with-hiv-aids/friends-and-family/having-children. Updated January 25, 2012. Accessed October 31, 2013.

Prevention of maternal-child HIV transmission. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated October 18, 2013. Accessed October 31, 2013.

Practice Committee of American Society for Reproductive Medicine. Recommendations for reducing the risk of viral transmission during fertility treatment with the use of autologous gametes: a committee opinion. Fertil Steril. 2013;99(2):340-346.

Pregnancy and HIV. The Well Project website. Available at: http://www.thewellproject.org/en%5FUS/Womens%5FCenter/Pregnancy%5Fand%5FHIV.jsp. Updated October 2012. Accessed October 31, 2013

Workowski KA, Berman S, Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2010. MMWR. 2010;59(No. RR-12):1-110.

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