HIV/AIDS Treatment and Care : Clinical protocols for the European ...

342
HIV/AIDS TREATMENT AND CARE CLINICAL PROTOCOLS FOR THE WHO EUROPEAN REGION
• Although data are limited, several studies have suggested there is an increased risk of spontaneous
abortion and stillbirth among women living with HIV (74).
• The effects of HIV infection on pregnancy outcomes are likely to be more pronounced among
women with symptomatic HIV infection (75).
• Pregnancy does not have an effect on HIV disease progression or mortality (76, 77).
• The risk of opportunistic infections among women with HIV does not appear to be altered by
pregnancy.
4. Counselling before conception
Assisting people living with HIV in decisions about childbearing requires counselling on:
• the risk of HIV transmission to the partner, and interventions that can reduce it (see the next
section);
• effects of HIV on pregnancy, including increased risk of certain adverse outcomes;
• the safety of ARVs during pregnancy, and their possible side-effects;
• the risk of birth defects while receiving particular ARVs; and
• the effectiveness of ARV prophylaxis, caesarean section and bottle-only feeding in reducing the
risk of MTCT.
5. Reducing the risk for sexual transmission of HIV during conception
Special support should be considered for couples with discordant serostatus wishing to conceive:
• They need reproductive counselling and assistance to limit the risk of HIV transmission to the
uninfected partner in unprotected sexual intercourse.
• Even though some serodiscordant couples have started pregnancies through timed unprotected
intercourse without infecting the negative partner, this practice is unsafe and is not recommended.
• Specific methods of sperm preparation and testing can substantially reduce the chance of HIV
transmission to the female partner (78, 79). Male-positive discordant couples who want to have
a child should be informed of risk-reduction techniques and encouraged to seek assistance at
institutions that can provide the most effective methods of sperm preparation.
5.1. Sperm-washing and virological determination of HIV in semen
Sperm washing can be carried out in any laboratory providing assisted reproduction services to
infertile couples. It is a three-step semen processing method consisting of:
1. gradient centrifugation to isolate motile spermatozoa and reduce the number of potentially infected
non-spermatozoa cells;
2. repeated washing of the cell preparation to eliminate cell-free virus; and
3. spontaneous migration to obtain an aliquot of motile virus-free spermatozoa (80, 81).
It is recommended that all processed samples be tested for HIV prior to insemination using polymerase
chain reaction techniques (82). HIV genome detection in semen requires special technical
equipment and skills. The use of universal infection control procedures and specific training should
be provided to laboratory staff to avoid HIV infection when handling potentially infectious semen.
6. Assisted reproductive technology in case of HIV infection
Fertility screening and STI diagnosis and treatment of both partners are needed before assisted reproductive
technology can be considered. A history of fertility, HIV-related parameters (including
CD4 count and viral load) and ART should be established.