Fertility choices and management for HIV-positive women.
OBJECTIVE
It is becoming increasingly important to address the issue of reproductive counselling and management of HIV-infected individuals during their reproductive years. Sexual and reproductive health-related needs and aspirations are similar to those of uninfected individuals but some differences require specific attention, which are discussed in this review.


RESULTS
Hormonal contraception should be used with caution in women on antiretroviral treatment. Its impact on both HIV infectivity and disease progression is still controversial. An intrauterine device can be considered for pregnancy prevention and pregnancy termination should be offered in safe conditions. HIV-infected women have a lower spontaneous fertility rate, which may persist after assisted reproduction. Data on safety of antiretroviral treatment during conception are reassuring. No clear association can be found between exposure to antiretrovirals and fetal abnormalities. Secondary prevention remains crucial and condom use remains a key method.


CONCLUSIONS
Different topics related to fertility choices among HIV-infected patients should be addressed. Family planning methods and termination of pregnancy have specific aspects among infected individuals. When needed, medically assisted reproduction may be required and antiretroviral treatment should be adapted before conception. Secondary prevention has a key role in reducing newly acquired infections.
aDepartment of Maternal-Fetal Medicine. Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clinic, University of Barcelona, IDIBAPS, Spain bEugin Clinic, Barcelona, Spain.
Oriol
O
Coll
Marta
M
Lopez
Sandra
S
Hernandez