title: Natural conception in HIV-serodiscordant couples with the infected partner in suppressive antiretroviral therapy: A prospective cohort study.
abstract: The potential of antiretroviral treatment (ART) to prevent the sexual transmission of HIV has increased the number of serodiscordant couples who are considering natural conception. We aim to describe the results of a protocol for reproductive counseling aimed at HIV serodiscordant couples who desire natural conception, in which the infected partner, the index case, is receiving suppressive antiretroviral treatment.A prospective cohort included all HIV serodiscordant couples attended a counseling program in the period 2002 to 2013 who opted for natural conception and met the following criteria: index case on ART with persistent plasma viral suppression for at least the previous 6 months, ART compliance over 95%, preserved immune status, undetectable HIV viral and proviral load in semen in male index cases, and absence of genitourinary infections and fertility problems in both members of the couple.Of the 161 HIV serodiscordant couples included, 133 with male index cases, 66% achieved at least 1 pregnancy, 18% a second one, and 5% a third pregnancy. A total of 144 natural pregnancies occurred and 107 babies were born. The pregnancy rate was 1.9 for each 100 acts of vaginal intercourse, and the mean time to conception was 6.1 months, both independently of the sex of the index case. No case of sexual or vertical HIV transmission occurred.In the absence of fertility problems and under controlled conditions, natural conception might be a safe and effective reproductive method for those HIV serodiscordant couples who choose this reproductive option.
authors.affiliation: Centro Sanitario Sandoval, Instituto de Investigación Sanitaria San Carlos -IdISSC Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid CIBER Epidemiología y Salud Pública Instituto de Salud Pública de Navarra, IdiSNA-Navarra Institute for Health Research, Pamplona, Spain.
authors.forename: Jorge
authors.initials: J
authors.lastname: Del Romero
authors.forename: María Begoña
authors.initials: MB
authors.lastname: Baza
authors.forename: Isabel
authors.initials: I
authors.lastname: Río
authors.forename: Adrián
authors.initials: A
authors.lastname: Jerónimo
authors.forename: Mar
authors.initials: M
authors.lastname: Vera
authors.forename: Victoria
authors.initials: V
authors.lastname: Hernando
authors.forename: Carmen
authors.initials: C
authors.lastname: Rodríguez
authors.forename: Jesús
authors.initials: J
authors.lastname: Castilla
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D005306:Fertilization / Q000187:drug effects*; D018023:HIV Seronegativity; D006679:HIV Seropositivity; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D011446:Prospective Studies; D027724:Reproductive Techniques, Assisted; D012731:Sex Counseling; D012747:Sexual Partners; D013030:Spain
chemical_list: D019380:Anti-HIV Agents