Thanks to health care, HIV-positive people – men and women – may have non-children affected by the disease, preserving their partners from any risk of contamination. If you have the project to have a child, first talk with your doctor: it can direct you to the most appropriate methods for your situation and preserving the best of the risk of passing HIV to your partner and to unborn child.
Presence of HIV in semen
HIV is found in semen than 90% of HIV-infected men not taking antiretroviral therapy.
Among HIV-positive men taking effective antiretroviral therapy and having an undetectable viral load, HIV is found in semen in 5% of cases having an undetectable viral load is therefore not always mean viral load undetectable in semen. Consequently, the risk of HIV transmission to an HIV-negative partner during unprotected sex persists.
The possibility of “washing” sperm
For a man with HIV who do not wish to risk of transmitting HIV to his partner but wishing to have a child, it is possible to use the “sperm washing”. This technique involves separating the different fractions component semen:
– Firstly, the seminal fluid. Seminal fluid may contain HIV as “free” (viral particles) or integrated to the cells (proviral DNA integrated to leukocytes present in the liquid);
– Secondly, sperm, that is to say human reproductive cells. Based on the available scientific data, HIV does not infect sperm. Sperm, separated and washed seminal fluid, are not HIV transmission vectors.
The fraction of sperm “prepared” is used to “fertilize” the partner according to the method: Artificial insemination (AI), in vitro fertilization (IVF) or IVF sperm microinjection (ICSI, for intracytoplasmic sperm injection).
The fraction of the sperm is deposited in the uterus of the partner. Fertilization (meeting of a sperm and an egg cell, reproductive cell of Women) is in the body of the woman, in situ. Ovarian stimulation may be performed in order to “boost” ovulation.
Chances of success: 15 to 20% per cycle. 6 cycles can be practiced.
After ovarian stimulation, mature eggs are collected by ultrasound guided vaginal puncture under local or general anesthesia. The collected oocytes are then prepared in the presence of sperm for fertilization. After 2 to 3 days culture in laboratory, one to three embryos obtained are transferred to the uterus of the woman. The embryos transferred and not frozen. They can be used for subsequent attempts.
IVF is a possible remedy for fertility problem (tubal obstruction in women, low sperm count in men) and in case of failure of AI.
Chances of success: 25 to 35% per cycle. Social Security supports 4 embryo transfers “fresh”. Frozen embryo transfers can then create additional chances for failure of the first attempts.
IVF sperm microinjection (ICSI):
This technique can be used when the sperm is poor sperm. The stages of oocyte retrieval in women are the same as for IVF “classic”. ICSI involves the injection of a sperm into an egg using a micropipette. (S) obtained embryo (s) is (are) transferred (s) in women, as for a conventional IVF.
Chances of success: 25 to 35% per cycle.
Having unprotected sex is not necessary to conceive a child. It is possible to perform a “craft insemination” without medical intervention: the man’s sperm can be retrieved from a condom without spermicide or in a suitable container, aspirated with a pipette (eg pipette used for pediatric medicines like Tylenol or Advil) or a small syringe 10-20 ml (without needle) and injected into the vagina of the woman with the same hardware. The syringe or pipette should be very clean, disinfected (non-sterile). Obviously, this “insemination” should be practiced at the time of ovulation (the time of ovulation can be determined by the temperature curve or Dipstick, please discuss this with your doctor).
Monitoring of pregnancy
Monitoring of pregnancy is especially important for women with HIV. Taking antiretroviral treatment during pregnancy (at least from the 2nd quarter) is essential to reduce the risk of transmission of HIV to the unborn child (beware, some antiretroviral therapy are cons-indicated during pregnancy and even at the moment of conception: the case of Sustiva or efavirenz). Childbirth can be done vaginally or by caesarean section, depending on the circumstances and the risk of HIV transmission. At birth, the child receives treatment during its first weeks of life, in order to further reduce the risk of transmission.
Currently in France, thanks to this medical treatment, the risk of transmission of HIV from mother to child is very small (less than 1%): the main event of child infections are in women n ‘ have not been tested during pregnancy and / or who have not had medical monitoring during pregnancy and / or who are in a situation of serious failure treatment.
HIV-positive women, with or without antiretroviral treatment, should not breastfeed their child transmission of HIV through breastfeeding is possible.
HIV infection diagnosed in children
During his first months of life, the child has the anti-HIV antibodies from his mother. Determining the diagnosis therefore requires the completion of a search of the proviral DNA in the cells or HIV RNA in the blood, by PCR (Polymerase Chain Reaction, Technical amplification of nucleic acids). These searches are done at birth and at 1, 3 and 6 months if the results are negative (uninfected). If a first result comes back positive (detection of infection), a second check may be carried out immediately.
Unprotected sex is never recommended, because of the potential risk-infection. According to the scientific literature, surcontaminations can lead to more rapid progression of the disease in people with HIV. This is why the sperm washing technique can be applied to the situation of “concordant couples.”
In all cases, it is important for the success of the project, that future parents have strict medical supervision, and the pregnancy is expected to reduce the risk of HIV transmission from mother to child.
Viral hepatitis B
– When the man reached by the hepatitis B virus (HBV) his partner must be vaccinated against hepatitis B, HBV is transmitted sexually. The possible transmission of HBV from man to the child, through integrated HBV DNA to sperm, is not well defined. When in doubt, the child can receive treatment at birth (see below) to reduce the risk to a minimum. This treatment is an extra precaution, in addition to effective vaccination of women.
– When a woman has HBV: HBV can be transmitted from mother to unborn child. As in the case of humans infected with HBV, vaccination partner is highly recommended. To take no risk of transmission of HBV to the partner (especially if the partner is not vaccinated), it is possible to use the same techniques insemination for HIV. Depending on circumstances, women may receive active treatment against HBV during pregnancy. Attention to pregnant women, adefovir is against-indicated, and tenofovir is not recommended. Available treatments may be prescribed are therefore limited.
– At birth, the child will receive a so-called treatment “serovaccination” effective in over 95% of cases. This treatment involves the administration of anti-HBV immunoglobulin IV (30 IU / kg to double if the presence of HBeAg) this administration is the day of birth, at 1 month and 6 months. This serovaccination may be performed if the man is infected with HBV, or if the woman is infected with HBV.
Viral hepatitis C
– When the woman reached by the hepatitis C virus (HCV) HCV can be transmitted from mother to unborn child. Unlike hepatitis B, hepatitis C can be eradicated by treatment, which unfortunately is heavy and binding (1 Year average treatment). Women with HCV with contemplating pregnancy should be offered treatment against HCV before attempting conception. This treatment, especially based ribavirin is strictly against-indicated during pregnancy because of the risk to the child. At the end of treatment, we must wait four months before trying to have a child, again because of the risks associated with ribavirin.
– When a person is infected with HCV: there is no risk of HCV transmission from the father to the unborn child (HCV does not multiply in the sperm). The challenge is therefore to protect his partner. The transmissibility of HCV unprotected sex (vaginal penetration) is low. HCV is found in small quantities in the semen of about 10% of men infected with HCV and 30% of co-infected men HIV-HCV. Cases of sexual transmission is rare if the reports are not “traumatic” and accompanied by injury or bleeding. Be careful though: a recent acute hepatitis C epidemic was observed in men who have sex with men. To reduce the risk of contamination of his partner and the future child, man can resort to sperm washing technique.
The HCV therapy may also be recommended before initiation of a child’s project. If the treatment is effective, it will have to wait seve