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conception- where the father is HIV+ and the mother HIV neg.
Feb 17, 2002

I work as an HIV counsellor in the UK and have two pairs of sero-discordant would-be parents. Although sperm washing is available here- the cost is ,for most people, prohibitive. These couples are desperate to have children of their own and I am aware that they do , from time to time, have unprotected sex. Being realistic about their situation, how might it be possible to reduce the risks to the woman as far as is humanly achievable. Thanks.

Response from Dr. Aberg

The best alternative is to have artificial insemination by a HIV negative donor. If the couple really want to have a baby, this is what I suggest.

1. The man should be on antiretroviral therapy and have an undetectable viral load in is blood. It would be nice to know if his seminal fluid was undetectable but obviously, this is still investigational.

2. Have the couple see someone who is competent at teaching the reproductive cycle so that the woman can take her temperature, etc to determine when she is ovulating. There are also over the counter kits which help time ovulation. Then have the couple have unprotected sex or artificial insemination only at that time. The couple must understand there is still a risk of the woman acquiring HIV regardless of the best intentions.

3. Some investigators have talked about the possibility of giving a short course of antiretroviral therapy to the woman as a prophylaxis (to prevent acquisition of HIV). There is no data on this and one should consider all risks of giving antiretroviral therapy to someone to prevent transmission. I am not recommending this. There are too many unanswered questions with this approach. I bring it up because I have heard of couples doing this.

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