Preexposure prophylaxis and timed intercourse for HIV-discordant couples willing to conceive a child

Vernazza, Pietro; Graf, Irma; Sonnenberg-Schwan, U.; Geit, Maria; Meurer, Anja

doi:10.1097/qad.0b013e32834a36d0

Cited by 177 publications

(96 citation statements)

References 10 publications

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“…[1][2][3][4][5][6][7][8] Yet in sub-Saharan Africa, where approximately 50% of couples with an HIV-infected partner are HIV-serodiscordant, these ''safer conception'' strategies are often unavailable or not discussed early enough with HIV-serodiscordant couples who desire children. 9,10 These couples would benefit from education and counseling about accessible and feasible safer conception strategies that protect HIV-uninfected partners during peri-conception (i.e., pregnancy attempts without condoms).…”

Section: Introductionmentioning

confidence: 99%

Fertility Decision-Making Among Kenyan HIV-Serodiscordant Couples Who Recently Conceived: Implications for Safer Conception Planning

Pintye

Ngure

Curran

et al. 2015

AIDS Patient Care and STDs

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HIV-serodiscordant couples often choose to attempt pregnancy despite their HIV transmission risk. Optimizing delivery of HIV risk reduction strategies during peri-conception periods (i.e., safer conception) requires understanding how HIV-serodiscordant couples approach fertility decisions. We conducted 36 in-depth individual interviews with male and female partners of Kenyan heterosexual HIV-serodiscordant couples who recently conceived. Transcripts were analyzed by gender and HIV serostatus using open coding. Matrices were used to identify patterns and emerging themes. Most participants expressed acceptance of being in an HIVserodiscordant couple and affirmed their resilience to live with serodiscordance and achieve their fertility goals. Overall, while the goal for childbearing was unchanged, conception became an urgent desire so that both partners could experience childrearing together while the HIV-infected partner was still healthy. Children also add value to the relationship, and multiple children were a commonly expressed desire. Couples' desires dominated those of individual partners in fertility decision-making, but male preferences were more influential when the individual desires differed. Values and preferences of the couple as a unit may mediate fertility decision-making in HIV-discordant couples. Thus, it is important that safer conception programs include both partners when appropriate and consider the relationship context during risk reduction counseling and when recommending risk reduction interventions.

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Section: Introductionmentioning

confidence: 99%

Fertility Decision-Making Among Kenyan HIV-Serodiscordant Couples Who Recently Conceived: Implications for Safer Conception Planning

Pintye

Ngure

Curran

et al. 2015

AIDS Patient Care and STDs

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“…Overview of fertility-related research areas for women of reproductive age. 23(45): [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] many factors aside from HIV influence decisions to terminate pregnancy, and that abortion is less common among women living with HIV in the antiretroviral era. 3,26 Further knowledge regarding post-abortion care and approaches to effectively integrate HIV and post-abortion care services should be expanded.…”

Section: Resultsmentioning

confidence: 99%

“…However, safer conception implementation has been largely limited to high income settings where resources and infrastructure facilitate options including spermwashing, intrauterine insemination (IUI), in-vitro fertilization (IVF), [39][40][41] and/or close monitoring of natural conception while using antiretrovirals. 42,43 Evidence from resource-limited settings has focused on the need for safer conception services, with efficacy and effectiveness verification of these interventions largely outstanding. 44 Although work is beginning to emerge in this area, key gaps include evaluation of the safety and efficacy of low-cost safer conception methods for HIV prevention, adherence to conception methods, time-topregnancy across methods, infertility figures, and comparative effectiveness of safer conception approaches including timed unprotected sex limited to peri-ovulatory periods, manual self-insemination, and unrestricted condomless sex while using antiretrovirals.…”

Section: Resultsmentioning

confidence: 99%

Fertility-related research needs among women at the margins

Schwartz¹,

Baral

2015

Reproductive Health Matters

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Fertility-related research encompasses fertility intentions, preconception care, research amongst pregnant women, and post-partum outcomes of mothers and children. However, some women remain underrepresented within this domain of study. Women frequently missing within fertility-related research include those who are already the most vulnerable to health disparities, including female sex workers, lesbian, gay, bisexual, and transgender women, women living with HIV, and women who use drugs. Yet characterization of the needs of these women is important, given their unique fertility-related concerns, including risks and barriers to care emanating from social stigmas and discrimination. This synthesis provides an overview of fertility-related evidence, highlighting where there are clear research gaps among marginalized women and the potential implications of these data shortfalls. Overall, research among marginalized women to date has addressed pregnancy prevention and in some cases fertility intentions, but the majority of studies have focused on postconception pregnancy safety and the well-being of the child. However, among female sex workers specifically, data on pregnancy safety and the well-being of the child are largely unavailable. Within each marginalized group, preconception care and effectiveness of conception methods are consistently understudied. Ultimately, the absence of epidemiologic, clinical and programmatic evidence limits the availability and quality of reproductive health services for all women and prevents social action to address these gaps.

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“…Absence of detectable HIV is verified before insemination using a polymerase chain reaction nucleic acidbased sequence amplification assay. Pregnancy rate per insemination is 14 %, based on a European experience of more than 2000 inseminations; to date, there have been no seroconversions in either mother or child [22]. Washed sperm have also been used in other assisted conception treatments, such as in vitro fertilization.…”

Section: Discussionmentioning

confidence: 99%

Yes, It is Possible

Allahbadia

2015

J Obstet Gynecol India

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Human immunodeficiency virus-serodiscordant couples are actively seeking reproductive assistance and often consider or practice unsafe measures to achieve pregnancy. Reproductive issues and concerns unique to these couples need to be addressed before treatment.Assisted reproduction techniques can minimize the risk of infection and complete families associated with serodiscordant couples. Since 1987, more than 4000 published attempts have been reported in which processed spermatozoa from HIV-seropositive men were used to establish pregnancy in HIV-seronegative women. When the female partner is HIV positive, intrauterine insemination (IUI) will suffice in order to prevent horizontal infection. However, when the male partner is HIV positive, a technique developed in Milan over 15 years ago, involving sperm washing, is used in order to minimize infection of the healthy partner. Some couples need further treatment, due to inherent infertility, with advanced reproductive technology (ART) procedures, such as IVF or ICSI. Recent innovative approaches such as pre-exposure prophylaxis

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Preexposure prophylaxis and timed intercourse for HIV-discordant couples willing to conceive a child

Cited by 177 publications

References 10 publications

Fertility Decision-Making Among Kenyan HIV-Serodiscordant Couples Who Recently Conceived: Implications for Safer Conception Planning

Fertility Decision-Making Among Kenyan HIV-Serodiscordant Couples Who Recently Conceived: Implications for Safer Conception Planning

Fertility-related research needs among women at the margins

Yes, It is Possible

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