As HIV infection has turned into a chronic non-life-threatening condition, the challenge remains to ensure infertile people living with HIV get equal access to ART treatment too.

Medical breakthroughs consisting of highly successful antiretroviral agents have made it feasible to keep HIV viral loads undetectable and therefore minimise almost to zero the chance of transmitting the virus during sexual intercourse.

Moreover, the recent introduction of pre-exposure prophylaxis (PrEP) in seronegative men when their partner is living with HIV, is another option to protect from viral transmission, especially when plans for pregnancy are ahead.

As more individuals living with HIV will choose to have children, assisted reproductive technology maybe required for indications not strictly relevant to reproductive pathology, but also, as an effective viral transmission risk-reducing strategy.

Much of the current medical research on the topic has mainly focused on HIV-positive men and less so on HIV-positive women. Despite evidence of antiretroviral efficiency in pregnant women to prevent perinatal transmission of HIV to the fetus and neonate, not much has been published with regards to treatment options for women living with HIV trying for a pregnancy with a seronegative partner.

In addition, legislation at some countries, can be quite restrictive when it comes to provision of infertility treatment services to serodiscordant couples. This, coupled with discrimination still being reported from people living with HIV, reflects the state of difficulty people living with HIV face when they get referred to medical consultation for infertility reasons.

Assisted reproductive technologies have been shown to be quite effective in terms of minimising the risk of viral transmission to almost zero, in serodiscordant couples living with HIV. Techniques such as sperm washing, intrauterine insemination and ICSI have all been put forward as effective strategies to minimise risk transmission, while at the same time, aiding with successful implantation and achievement of pregnancy.

At present, more effort should be made to ensure equal access of people living with HIV to infertility services. Increased awareness and detailed knowledge of available treatment strategies among policy makers and health professionals in assisted reproductive technology units, is urgently required to tackle the issue of discrimination currently experienced by people living with HIV.

©2021, Nicholas Christoforidis, Fertility Matters
Reproduction without explicit permission is prohibited. All rights reserved.