Guidelines for an HIV safe pregnancy
Clinicians have released a set of guidelines for assisting HIV positive couples wishing to fall pregnant.
HIV Clinicians this week released a set of ground-breaking consensus guidelines for clinicians who assist HIV positive individual and couples wishing to fall pregnant.

Released on the eve of the 5th South African AIDS conference in Durban, the guidelines revealed that the vast majority of HIV-positive individuals in South Africa are of reproductive age with 29% of South Africa’s 1 million annual births occurring in women living with HIV.

The expert committee which formulated the guidelines published in the latest Southern African Journal of HIV Medicine said that dealing with issues of fertility and childbearing should be seen as part of routine HIV care.

“Clinicians are responsible for identifying and supporting the fertility desires of their HIV-infected patients – both in the interests of ‘normalising’ the lives of people living with this chronic infection and to help ensure that conception, pregnancy and delivery take place with the least possible risk to the mother, her partner and the resulting child,” said the committee, which was chaired by Prof Linda-Gail Bekker and Dr Vivien Black.

The guidelines were designed to assist clinicians to identify patients’ fertility desires and to give safe and effective conception guidance to a presumed fertile couple when one or more partners are HIV infected.

In their deliberations the committee considered resource intensive settings, mostly in private facilities, as well as resource-limited settings mostly found in the public sector.

The guidelines also offer other options to consider, which patients may not be aware of:

  • An HIV-infected male partner may consider HIV negative sperm donation.
  • Adoption may be a possible as chronic illnesses that are well controlled should not be a hurdle.
  • Surrogacy may be an option, but would only be acceptable if the male partner is HIV-negative.
  • Before the availability ART, conception was discouraged where one or both the parents were HIV-positive and because of the risk of transmission to the baby.

In the age of ART, HIV is viewed as a manageable chronic illness, leading to dramatic reductions in morbidity and mortality and a reduction of paediatric infections.

The guidelines discuss how the clinician can raise the issue of childbearing and help identify the fertility desires of HIV-infected women and men, with a brief discussion on contraception options for women who do not wish to become pregnant.

The risks of HIV transmission depend on the viral load, the presence of sexually transmitted infections and the length and frequency of exposure.

Viral load is the single greatest risk factor for all transmission modes with ART reducing the risk of transmission by controlling the amount of HIV in the blood.

The HPTN 052 study found that initiation of ART by HIV-infected individuals substantially protected their HIV-uninfected sexual partners from acquiring HIV infection, with a 96% reduction in risk of HIV transmission.

“It is high time the lives of people living positively with HIV are normalised,” the committee said.

What do you think of the new guidelines?

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