Human immunodeficiency virus serodiscordant couples on highly active antiretroviral therapies with undetectable viral load: conception by unprotected sexual intercourse or by assisted reproduction techniques?
Until recently, only assisted reproduction was proposed to serodiscordant couples wishing to conceive. Nevertheless, recent publications have proposed unprotected sexual intercourse, targeting fertile days, for couples where antiretroviral treatment has lowered blood viral load to an undetectable level. Available data and the arguments for and against conception by safe sex versus the use of a strategy of unprotected sexual intercourse targeting fertile days are reviewed and analyzed. Although the rate of transmission of human immunodeficiency virus in serodiscordant couples in precise conditions (such as an undetectable viral load on treatment by highly active antiretroviral therapies and sexual intercourse limited to the fertile days) is very low, not zero, here we stress the various factors which can increase the risk of seroconversion in this particular population. In this context, it seems less cautious to abandon the recommendations of safe sex in serodiscordant couples desiring a child. The recourse to medically assisted procreation is advised, as long as evidence from further studies does not show that unprotected sexual intercourse, targeted to fertile days, does not have unexpected harmful consequences.
Vandermaelen
Aline
A
Laboratory for Research on Human Reproduction, Medicine Faculty and Department of Obstetrics and Gynaecology, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium.
Englert
Yvon
Y
D000293:Adolescent; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D003075:Coitus; D005260:Female; D005306:Fertilization; D015658:HIV Infections / Q000635:transmission*; D006679:HIV Seropositivity; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D008297:Male; D011247:Pregnancy; D027724:Reproductive Techniques, Assisted; D021841:Safe Sex; D019562:Viral Load