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hiv and wanting to get pregnant
Mar 8, 2000

I'm a Dutch woman, I have got HIV for at least 5 years now but I'm not on any medication. I would very much like to get pregnant, but because my husband (who hasn't got HIV) has problems with his fertility there is no other way to get pregnant but through IVF. I have a couple of questions about that:

* My doctor says IVF can't be given to women with HIV. Why is that and do you agree with him?

* My doctor also says I might be a "Long Term Non Progressor", which could mean I don't have to take medicines for a very long time. That is important to me because it would mean I have a better chance in the future when vaccines or better medicines might become available.

My question to you is: if I was going to become pregnant, would that mean I have to take medication no matter what (because of the transmission to the baby), or are there ways around that, for instance taking medicines only for a short period of time, combined to having an elected caesarian birth? What would you advise me? Thank you very much for your answers!

Response from Dr. Cohen

All of these questions are tough ones and there are no right answers.

I don't know of any medical reason why IVF would not be reasonable in an HIV infected woman. It might have to do with the government's willingness to pay (IVF is very expensive) or the reluctance of the fertility clinic to operate on an HIV+ woman.

You don't mention your CD4 count and viral load, but it makes sense to delay treatment if you are not progressing to hold out for better medications. At this point, the evidence suggests that the best way to prevent transmission to the baby is to take combination therapy that reduces your viral load to undetectable. Elective caesarian section does have an additional benefit, but for untreated women, it reduced the risk from 20% to 10% in the large meta analysis, while combination therapy reduces transmission to something around 1%. One month of AZT alone in the Thai study reduced the risk to about 9%; adding C section might drop that to 2-4% but still not as good as combination therapy. Still, if you were to start on a combination regimen for the final 3-4 months of pregnancy and reduce your viral load to undetectable and then stop after the baby is born, it is not likely to ruin your chances of using those drugs again, or of waiting for newer treatments.

Good luck



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