Diagnostics and treatment of HIV-discordant couples who wish to have children

Over the last years the reality surrounding HIV-infection has undergone a c onsiderable change with regard to the life expectancy of patients, and the plans they can make for their lives. Because the majority of the HIV positi ve population is of reproductive age, one of these plans might be to have c hildren, often as an expression of a fulfilled partnership. The need for me dical support to realize this wish, however, is often confronted with ethic al, medical or forensic restraints. For this reason, interdisciplinary reco mmendations have now been developed -for the first time on a global basis - which aim to provide guidelines for practitioners in this complicated area . Care and support of HIV-positive individuals who desire children is an inte rdisciplinary task. If the occasion should arise, non-medical psycho-social measures also have to be integrated. Factors to be considered in couple co unseling include disease progression, early and comprehensive infection dia gnostics, and fertility screening for both partners. All steps of diagnosti cs and treatment have to be documented completely, and written documentatio n must be obtained from the affected individuals stating that they clearly understand the remaining risk of infection for the healthy partner and even the child. If one of the partners is not compliant or has an advanced stag e of HIV-disease (CDC B3 or C), active reproductive support should not be p rovided. HIV-positive women should be informed about the possibility of self-insemin ation so that the healthy partner is protected from HIV-infection. Medical measures taken to reestablish fertility or optimize conception are acceptab le as long as polyovulations are prevented. However, there are forensic res ervations with respect to assisted reproduction techniques due to the remai ning risk of materno-fetal transmission which under optimized conditions is low, but still quantifiable. Wherever the male partner is HIV-infected, infectious viral particles can b e separated from motile spermatozoa by density gradient centrifugation and subsequent swim-up. To exclude the possibility of viral contamination to th e greatest degree of certainty, one aliquot from each prepared sample shoul d be tested for HIV nucleic acid using highly sensitive detection methods. As a rule, this requires cryo-preservation. Processed, tested sperm samples can then be used for all techniques of assisted reproduction in the health y female partner.