Hello Dr. Bob,

I'm Positive and my husband is negative. We desperately want to get pregnant and have a family. I know from reading your forum that there are some medical techniques that decrease that risk for magnet couples but I strongly doubt we have those here and we wouldn't be able to afford them even if we did. We plan to try getting pregnant anyway. Any advice or encouragement? Thanks,

Magnetic Mommie-wanna-be.

Hi,

Yes, I do understand your dilemma. We know that the use of antiretroviral agents has reduced the risk of mother-to-child transmission to less than 2%, but HIV-positive individuals can potentially transmit the virus to an HIV-negative partner while trying to conceive. The assisted reproduction methods you refer to, including artificial insemination, in vitro fertilization and sperm washing techniques, can indeed further reduce the risk of sexual transmission. However, these techniques are cumbersome, expensive and not widely available in many parts of the world.

I can give you some encouraging news from a recent Spanish study. They reviewed the medical records of 62 HIV magnetic couples who achieved natural pregnancies without medical assistance. There were 22 couples in which the woman was HIV-positive and 40 couples in which the man was positive. Importantly, at the time of conception, all of the HIV-positive partners were receiving HAART and had undetectable plasma viral loads. In addition, all the HIV-positive women maintained undetectable HIV RNAs during their pregnancies and at the time of delivery. Overall, 76 natural pregnancies occurred and 68 children were born. There were no recorded cases of HIV seroconversion in any of the uninfected partners. One woman did transmit HIV to her baby despite prophylactic therapy. This study suggests that magnetic couples with undetectable viral loads on HAART have a relatively minimal risk of sexual transmission. I must point out this is a relatively small study and does not prove there is no risk. It merely gives us some idea that the risk under these circumstances may well be less than many of us had feared. If assisted reproductive methods are not available to you (due to cost or location), I strongly urge you to:

1. Make sure your plasma viral load is undetectable and remains undetectable throughout your pregnancy. An HIV-knowledgeable obstetrician can advise you as the safest HAART regimens. Some drugs, such as Sustiva, need to be avoided during pregnancy.

2. Restrict your unprotected intercourse to the fertile days of your menstrual cycle to minimize the risk of sexual transmission while maximizing the odds of pregnancy.

Good luck!

Dr. Bob