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Plan to conceive..

Aug 7, 2017

Hi doctor young. Greetings from Singapore! My Husband is positive n I m negative. We are planning to conceive n am faced with the challenging question on how to do it safely.

He is currently on atripla for 4th year, undetectable. We are playing with the idea of going for PREP or go for sperm washing. His specialist however is very against the idea of PREP n much rather us to go for sperm washing as he deems safer.

I would like to seek your opinion on this matter. If we were to go for Truvada option, how Long should I be taking the medication before we start trying? Is there any blood test etc that I should be taking to ensure I m ok with truvada?

Response from Dr. Young

Hello and thanks for posting your important question from Singapore.

The desire to plan and have children is very important to many people living with HIV. Family planning for positive people has been wrapped in concerns about transmission of the virus and modern strategies are obscured by emphasis on condoms for prevention.

Respectfully, I disagree with your husband's HIV specialist.

When the positive partner is not on effective ART, sperm washing can reduce risk of infection- both endorsed by (in my opinion, already outdated) recent US CDC guidelines for Preventing HIV Infection Among HIV-Uninfected Women Attempting Conception with HIV-Infected Men.

Separately, pre-exposure prophylaxis (PrEP) when started before condomless sexual exposure (some experts recommend 7 days for women, 2 days for men) is a highly effective means of preventing HIV infection. Regarding laboratory monitoring for PrEP, the US CDC PrEP Guidelines offer recommendations, including assessments of hepatitis B virus infection and kidney function tests (as well as HIV antibody tests). Our clinic in Denver is caring for hundreds of at-risk HIV-negative individuals on PrEP using these recommendations. They're generally straightforward and acceptable by patient and provider alike.

Both of these strategies are (in my opinion) unnecessary if the positive partner is adherent to ART and has a low, if not undetectable HIV viral load. Several large clinical studies have failed to show linked sexual transmission from treated positive to negative person, even after tens of thousand documented condomless sexual encounters. The U=U campaign captures this scientific observation into the simple statement that undetectable equals untransmittable. U=U has been endorsed by community and medical groups around the world, including the Joint United Nations Programme on HIV/AIDS (UNAIDS) and our own International Association of Providers of AIDS Care (IAPAC). For this reason, even with an abundance of caution, given that your husband has been on treatment and has had undetectable virus for 4 years, I'd feel that neither sperm washing or PrEP would be necessary to protect you and facilitate a planned conception.

I hope that this is helpful and wish you and your husband good health. BY



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