HIV and reproductive care

Three-quarters of individuals infected with HIV are in their reproductive years and can expect an almost normal life expectancy under antiretroviral treatment. Men and women with HIV face the possibility of viral transmission to their partner or offspring if they want to have a child by way of spontaneous conception. When only the man is infected, spermatozoa can be isolated from seminal plasma and leukocytes containing cell-free and cell-associated HIV. After processing, the spermatozoa must be tested for residual contamination and, when negative, can be used for intrauterine transfer or in vitro fertilisation (IVF) embryo transfer/intracytoplasmatic sperm injection (ICSI). In women with HIV, self-insemination might be indicated when the couple is fertile or IVF embryo transfer/ICSI when there are infertility problems. Pregnancy should be planned to minimise the risk of drug-induced toxicity for the conceptus while reducing the vertical transmission rate to a minimum. Elective Caesarean birth is the recommended mode of delivery and breastfeeding is contraindicated.