{"id":8396,"date":"2017-06-04T11:32:56","date_gmt":"2017-06-04T15:32:56","guid":{"rendered":"http:\/\/blogs.nejm.org\/hiv-id-observations\/?p=8396"},"modified":"2017-06-05T15:07:38","modified_gmt":"2017-06-05T19:07:38","slug":"cant-hiv-serodiscordant-couples-now-just-children-regular-way","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/cant-hiv-serodiscordant-couples-now-just-children-regular-way\/2017\/06\/04\/","title":{"rendered":"Can’t HIV Serodiscordant Couples Now Just Have Children the Regular Way?"},"content":{"rendered":"
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Cartoon people getting important counseling about having children.<\/p><\/div>\n

MMWR just published a paper entitled,\u00a0Strategies for Preventing HIV Infection Among HIV-Uninfected Women Attempting Conception with HIV-Infected Men \u2014 United States<\/a>,<\/em> and it’s both a welcome and a very strange document\u00a0indeed.<\/p>\n

It’s welcome because it acknowledges that serodiscordant couples may wish to have children without the use of an HIV-negative sperm donor. Advances in HIV prevention mean they can drop their categorical\u00a0recommendation\u00a0against insemination with semen from HIV-infected men, one they originally made in 1990.<\/p>\n

But it’s strange because, right alongside treatment\u00a0of the HIV-positive man with antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) for the woman, is\u00a0a fairly lengthy data summary on “sperm washing”, a strategy\u00a0many would argue has outlived its usefulness.<\/p>\n

This is the short version of the procedure:<\/p>\n

Another strategy that can be used in conjunction with HAART and PrEP is collection and washing of the male partner\u2019s sperm to remove cells infected with HIV, followed by testing to confirm the absence of HIV prior to intrauterine insemination (IUI) of the female partner or in vitro fertilization (IVF).<\/p><\/blockquote>\n

Does one really need to put couples through this expensive and\u00a0time-consuming process when the risk of transmission is unmeasurably tiny, if not zero, if the man is on suppressive ART and the woman is taking PrEP? Can you imagine the number needed to treat<\/a> to prevent one additional case of HIV transmission with sperm washing in addition to ART and PrEP?<\/p>\n

It’s like wearing a belt, suspenders, and<\/em> using duct tape to keep your pants up (which is probably not the best analogy when discussing something that has to do with sex, but I’m going\u00a0with it).<\/p>\n

As a quick reminder:<\/p>\n