Does ART Provide a Way for HIV-Mixed Status Couples to Conceive?

For HIV-mixed status couples attempting conception, prior effective antiretroviral therapy (ART) can profoundly reduce the risk of sexual transmission of the disease, according to a report published in the Morbidity and Mortality Weekly Report.

The researchers analyzed data from 3 multinational studies that examined suppressing HIV replication with ART to reduce the risk for sexual transmission. The studies followed 3000 sexually active serodiscordant couples over several years while they did not use condoms. As a result, 2 of the studies quantified the extent of sexual exposures. In total, 548 heterosexual couples and 658 male-male couples from 14 European countries, Australia, Brazil, and Thailand, engaged in >74,000 condomless episodes of intercourse over the study period.

In all 3 studies, no HIV transmission to the uninfected partner was observed while the partner with HIV was virologically suppressed with ART.

The researchers noted that, in recent studies, men taking ART with no detectable HIV RNA in their peripheral blood have had HIV genetic material detected in their semen. However, it is not known whether this detection represents the presence of replicating virus at sufficient concentration to transmit infection.

The researchers indicated that serodiscordant couples attempting conception can also reduce transmission risk by decreasing frequency of sexual contact and limiting intercourse to the time of ovulation. Other measures such as preexposure prophylaxis or the use of intrauterine insemination or in vitro fertilization are potential options for couples planning to conceive.

Health care providers should regularly assess mixed HIV-status couples’ plans for conception, and take various factors such as risk tolerance, personal health, and cost into account when counseling, the researchers concluded.

Reference

Brooks JT, Kawwass JF, Smith DK, et al. Effects of antiretroviral therapy to prevent HIV transmission to women in couples attempting conception when the man has HIV infection. MMWR. 2017. 66(32);859-860. https://www.cdc.gov/mmwr/volumes/66/wr/mm6632e1.htm?s_cid=mm6632e1_w.