Pregnancy, parenting and HIV

He's positive, she's negative

Conception when the male partner is HIV-positive is tricky, since logic dictates that he must use a condom to protect the female from becoming infected.

Some researchers believe they've discovered a low-risk conception option that involves artificial insemination. The relatively simple procedure is called "sperm washing." For years, it's been used in sperm banks and infertility clinics to boost sperm potency. Scientists studying the technique have found that it lowers the level of HIV in the semen. Some claim it nearly eliminates the virus, while others call it a gamble.

Sperm washing for HIV-positive men is available in Italy, the United Kingdom, Spain, and Switzerland.

The technique appears promising, but is extremely controversial. Although published results appear to support claims of safety, "the definitive study to prove its safety remains to be published," says Andrew Helfgott, MD, clinical professor of obstetrics and gynecology at the University of Florida-Pensacola.

The U.S. Centers for Disease Control and Prevention (CDC) continues to investigate sperm washing. For now, its official stand is a warning that no evidence exists that any procedure can reliably remove all HIV from semen and it recommends against artificial insemination with semen from HIV-positive men.

She's positive, he's negative

Doctors treat pregnant HIV-positive women with the drug AZT, which has reduced mother-to-baby infection rates to approximately 8%. Delivering via Cesarean section may lower the risk even more, as long as it is an elective Cesarean section; that is, the mother is not allowed to begin labor. As long as the membranes are intact, pathogens have a tougher time entering the uterus and infecting the fetus. Researchers presume that the membranes confer this protection against HIV as well, and assume that the virus gains entry to the womb after the membranes rupture and labor begins.

Factors contributing to the likelihood of a HIV-positive mother passing the infection to her child include the stage of HIV the mother is in, if she's taking HIV medications, and how she has responded to medications.

When both prospective parents are positive

People may believe that if both partners have HIV, then they needn't worry about infecting each other. Right? Wrong.

"You may have different strains of the virus," Dr. Williams cautions. "One strain might be a more aggressive form. You must still be very careful."

Some people with HIV choose unprotected intercourse for conception, despite the danger. Estimates of risk of partner infection for one act of unprotected vaginal sex vary widely, ranging from 1 in 500 to 1 in 5,000,000. According to the CDC, women are eight times more likely than men to become infected from a single act of intercourse. Infection from female to male occurs, although it's less common.

The numbers might look small, but the risk of fatal illness looms large. And, despite optimum conditions and the best medical interventions, the baby can become infected.

Difficult decisions

Dr. Helfgott respects his patients' abilities and rights to make their own decisions and does his best to educate them. His patients know their risks and what they can do to minimize them. They understand the worst-case scenario for their situations, as well as the best.

If a patient decides to become pregnant despite the risks, Dr. Helfgott plans for the best circumstances. First, he confirms the absence of sexually transmitted diseases. Conception is scheduled during ovulation, to minimize exposure time. With optimal viral suppression and immune function brought about by drug therapy, he has been able to achieve good lab values.

And then, he says, "We hope for the best."