title: [Reproductive options for people living with HIV: 2013 guidelines from the French expert working group].
abstract: The desire for children is a legitimate aspiration that should be part of multidisciplinary care for all men, women or couples living with HIV. The use of effective antiretroviral therapy has revolutionized the prevention of sexual, as well as mother-to-child HIV transmission. When the HIV plasma viral load is undetectable on long-term antiretroviral therapy, the risk of mother-to-child transmission is <1% and the risk of heterosexual HIV transmission without condom use in a stable relationship is very low (estimated at less than 1/10,000) in the absence of inflammation of the genital tract. In a man with a long-term undetectable viral load, viral shedding in semen is uncommon, but may occur persistently or intermittently. The same appears true of viral shedding in the vaginal tract of women. Reproductive options are: natural conception, self-insemination when the woman is HIV-infected, assisted reproduction. Natural conception is now considered to be an acceptable option when the conditions are met, after exploring four aspects: (1) virological (viral load undetectable sustained for at least 6 months on therapy), (2) genital (absence of genital infections or lesions), (3) fertility (after appropriate evaluation) and (4) detecting the ovulation period to limit intercourse without condoms. Assisted reproduction has two objectives in the context of HIV, to allow the couple to conceive without abandoning condom use and/or to treat infertility.
authors: Service de gynécologie-obstétrique, CHU Louis-Mourier, AP-HP, université Denis-Diderot, 178, rue des Renouillers, 92700 Colombes, France. Electronic address: laurent.mandelbrot@lmr.aphp.fr.
authors: L
authors: L
authors: Mandelbrot
authors: Service de gynécologie-obstétrique, CHU Paule-de-Viguier, 330, avenue de Grande-Bretagne, 31059 Toulouse, France.
authors: A
authors: A
authors: Berrebi
authors: Service de virologie, CHU Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France.
authors: C
authors: C
authors: Rouzioux
authors: COREVIH, CHRU de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France.
authors: M
authors: M
authors: Partisani
authors: Service de gynécologie-obstétrique, CHU Trousseau, AP-HP, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France.
authors: P
authors: P
authors: Faucher
authors: Infectiologie, CHU de la Pitié-Salpêtrière, AP-HP, 13, boulevard de l'Hôpital, 75013 Paris, France.
authors: R
authors: R
authors: Tubiana
authors: Service de maladies infectieuses, CHU Bichat, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France.
authors: S
authors: S
authors: Matheron
authors: Service de biologie de la Reproduction, CHU de Toulouse, 330, avenue de la Grande Bretagne, 31059 Toulouse, France.
authors: L
authors: L
authors: Bujan
authors: Service de médecine interne et des maladies infectieuses, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France.
authors: P
authors: P
authors: Morlat
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D017280:Condoms; D005260:Female; D005306:Fertilization; D015658:HIV Infections / Q000188:drug therapy / Q000517:prevention & control / Q000635:transmission*; D020010:Heterosexuality; D006801:Humans; D007315:Insemination, Artificial; D008297:Male; D012098:Reproduction; D027724:Reproductive Techniques, Assisted; D012661:Semen / Q000821:virology; D014621:Vagina / Q000821:virology; D017201:Virus Shedding
chemical_list: D044966:Anti-Retroviral Agents
keywords: AMP; Assisted reproduction techniques; HIV; Heterosexual transmission; Procréation; Reproduction; Risque viral; Semen; Sperme; Transmission hétérosexuelle; VIH; Viral risk