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Serodiscoordinate Couple Trying to Conceive
Jul 30, 2002

I am an HIV+ male involved with an HIV- woman. My virus is undetectable, so she and I always have unprotected sex, however, I never ejaculate in her. I read an article where there have been studies showing that there has never been a documented transmission of HIV when the viral load is <1500 copies. Now were considering having a baby. With all that Ive said, do you think it is safe to plot her ovulation and go all the way (ejaculation) with the objective of conception? Is there anything that we could do minimize the risk of infecting her while trying to conceive? Or, are we merely living in denial and really playing Russian Roulette by having unprotected sex?

One more question: Are there increased risk of complications for the baby if she were to seroconvert during pregnancy?

Thank you for your awesome website!

Response from Dr. Remien

While the relative risk of transmission is lower when HIV viral load is lower, transmission of HIV is always possible. An "undetectable" viral load simply means that it is lower than the sensitivity of the test that is used to measure it. However, everyone living with HIV has viral replication occurring at all times. Viral load can fluctuate and the results of the test are only a measure of the viral load when the sample was taken. Also, the test results that people receive are a measure of the viral load of their plasma (blood). While there is a general correlation between plasma viral load and viral load of genital secretions, it is not a one-to-one correspondence.

Couples in your situation need to weigh the risks and decide together what they want to do about trying to get pregnant. If your wife were to seroconvert while getting pregnant then there is the risk of passing HIV on to the baby. Please speak with a physician about all of this, including possible specific strategies that may help reduce the risk of transmission of HIV while trying to conceive, if that is something you both want to pursue.


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