CDC Outlines Options for HIV-Discordant Couples Who Want to Conceive

HIV-discordant couples — in which only one partner is HIV-infected — have several options for attempting to conceive while minimizing the uninfected partner's risk, the CDC reports in MMWR.

When the woman is HIV-positive, the couple can use autologous sperm intrauterine insemination (IUI) to conceive without putting the man at risk. When the man is HIV-positive, the couple may choose to:

• Use sperm from an HIV-negative donor; this is the safest option.
• Use highly active antiretroviral therapy (HAART) to suppress HIV in the man and have condomless intercourse only near ovulation while the woman is using daily preexposure prophylaxis (PrEP).
• Have the man's sperm collected and "washed" to remove HIV-infected cells. After washing (described in MMWR below), the sperm are tested to confirm the absence of HIV and then used during IUI or in vitro fertilization. This procedure — which should be used in conjunction with HAART and PrEP — has been performed roughly 11,500 times, with no HIV transmissions to the woman or offspring.

HIV expert Dr. Paul Sax commented, "While it is helpful to outline strategies in which serodiscordant couples can safely conceive children, the additional protection afforded by semen processing in addition to suppressive HIV therapy for the male and PrEP for the female must be small, or even negligible."

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