Abstract
BackgroundFemale positive/male negative HIV-serodiscordant couples express a desire for children and may engage in condomless sex to become pregnant. Current guidelines recommend antiretroviral treatment in HIV-serodiscordant couples, yet HIV RNA viral suppression may not be routinely assessed or guaranteed and pre-exposure prophylaxis may not be readily available. Therefore, options for becoming pregnant while limiting HIV transmission should be offered and accessible to HIV-affected couples desiring children.MethodsA prospective pilot study of female positive/male negative HIV-serodiscordant couples desiring children was conducted to evaluate the acceptability, feasibility, and effectiveness of timed vaginal insemination. Eligible women were 18–34 years with regular menses. Prior to timed vaginal insemination, couples were observed for two months, and tested and treated for sexually transmitted infections. Timed vaginal insemination was performed for up to six menstrual cycles. A fertility evaluation and HIV RNA viral load assessment was offered to couples who did not become pregnant.FindingsForty female positive/male negative HIV-serodiscordant couples were enrolled; 17 (42.5%) exited prior to timed vaginal insemination. Twenty-three couples (57.5%) were introduced to timed vaginal insemination; eight (34.8%) achieved pregnancy, and six live births resulted without a case of HIV transmission. Seven couples completed a fertility evaluation. Four women had no demonstrable tubal patency bilaterally; one male partner had decreased sperm motility. Five women had unilateral/bilateral tubal patency; and seven women had an HIV RNA viral load (≥ 400 copies/mL).ConclusionTimed vaginal insemination is an acceptable, feasible, and effective method for attempting pregnancy. Given the desire for children and inadequate viral suppression, interventions to support safely becoming pregnant should be integrated into HIV prevention programs.
Highlights
With the increased availability of antiretroviral (ARV) therapy, HIV-infected individuals are living with HIV as a chronic disease [1]
Given the desire for children and inadequate viral suppression, interventions to support safely becoming pregnant should be integrated into HIV prevention programs
Feasibility, and effectiveness of timed vaginal insemination (TVI) as a safer method of becoming pregnant among ♀+/♂- HIV-serodiscordant couples in Kisumu, Kenya
Summary
With the increased availability of antiretroviral (ARV) therapy, HIV-infected individuals are living with HIV as a chronic disease [1]. In SSA, comprehensive reproductive counseling and services that support safely becoming pregnant are currently limited for HIV-affected individuals and couples desiring children [1, 9]. In female-positive/ male-negative (♀+/♂-) HIV-serodiscordant couples, timed vaginal insemination (TVI) of semen during the fertile period of the menstrual cycle, as well as consistent male condom use that essentially eliminates the risk of sexual HIV transmission when attempting pregnancy are easy, safe, convenient, and inexpensive reproductive options [9, 11, 12]. Other methods of safely becoming pregnant for HIV-affected couples desiring children should be evaluated and integrated into comprehensive HIV prevention and reproductive health services [1, 16, 17]. Current guidelines recommend antiretroviral treatment in HIV-serodiscordant couples, yet HIV RNA viral suppression may not be routinely assessed or guaranteed and pre-exposure prophylaxis may not be readily available. Options for becoming pregnant while limiting HIV transmission should be offered and accessible to HIV-affected couples desiring children
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