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    Thursday, September 14, 2017

    Can An HIV Negative Woman And Her HIV Positive Partner Conceive Naturally?

    What are the chances of a woman contracting HIV from her HIV positive man?
    An HIV negative woman and an HIV positive man (discordant couple) can marry and conceive naturally. There are certain measures which are very important to be considered to make an HIV negative woman to remain negative.


    Statistically, it is much harder to transmit HIV than to get pregnant. You will have the highest risk of pregnancy by having unprotected sex one or two days before your ovulation starts; when the ovary releases the egg. This is a 20%-30% chance. The risk of contracting HIV during vaginal penetration, for a woman, is 1 per 1,250 exposures (or 0.08 percent); for the man in that scenario, it’s 1 per 2,500 exposures (0.04 percent, which is the same as performing MouthAction). So, a woman is about 300 times more likely to get pregnant than to contract HIV from an HIV positive man.

    To make this safe, your partner must have an undetectable viral load for at least 6 months. The risk then become close to zero. This is the first important step that must take place and a very necessary criterion for marriage and conception to take place. The HIV positive man must have been on Anti-Retroviral Therapy (ART) consistently for over six months to have achieved an undetectable viral load. This is very important as low viral load is a direct indication that the virus is undetectable in body fluids which are semen, blood and vaginal secretions. Hence, the risk of transmission is almost zero.

    Then the next step is limited conception attempts during the most fertile days of your cycle. i.e when you are ovulating. Sexual activities should be tailored towards the ovulation period of the woman. A low number of conception attempts has a very low risk if the HIV positive person has an undetectable viral load. It is also still recommended that couples use condoms when the woman is not ovulating, or has become pregnant.

    Therefore, limited conception attempts made during ovulation may carry a low risk if your partner’s viral load is undetectable.

    Sometimes PrEP [Pre exposure Prophylaxis] and PEP [Post Exposure Prophylaxis] are used as an additional precautions. This involves taking a single dose of treatment before and after having sex.

    PrEP is not likely to add much or any protection, because having an undetectable viral load is enough. It might help for psychologically if you are nervous. PrEP is very effective too.

    One study followed 91 HIV serodiscordant couples, 43 were positive in male partners and 48 were positive in female partners. There were 196 unprotected vaginal intercourses, 100 natural conception and 97 newborns. There were no cases of HIV seroconversion in uninfected sexual partners. Natural conception may be an acceptable option in HIV-serodiscordant couples in resource limited settings if HIV-positive individuals have undetectable viremia on HAART, combined with HIV counseling, PrEP, PEP and timed intercourse. [1]

    The PARTNER study reported zero HIV transmissions after 800 couples had sex more than 58,000 times without a condom when the positive partner had an undetectable viral load. [2]

    How often should she get tested and how long does it take for the infection to be detectable?
    HIV antibody tests do not work as soon as you are infected. This is because it usually takes several weeks to generate antibodies to HIV. This is called the ‘window period’. Most people generate this response within 4–6 weeks, but approximately 5% of people take up to 3 months. Very rarely it can take longer.

    The result of an antibody tests therefore only tells your your HIV status three months prior to the test. This is why people are advised to re-test three months after the exposure if you test at 4-6 weeks, or to wait three months before taking an HIV test.

    Taking an antibody test less than 4 weeks after exposure will not tell you very much. You need to wait until at least 4–6 weeks after the exposure. [3]

    Will the baby automatically be HIV positive?

    As you are HIV negative, the baby will be HIV negative. If you are HIV positive and your viral load is undetectable, the chance your baby will be HIV positive is zero.

    Will my baby be at risk?

    Your baby can be at risk if you become HIV positive whilst pregnant and your viral load is very high. Returning to using condoms after you become pregnant might still be a good idea, even when your partners viral load is undetectable.

    A high viral load is one of the main risk factors for transmission. If viral load is detectable, there is a higher risk of catching HIV during pregnancy.

    Transmission to the baby can occur at 3 stages, but only if you become HIV positive.

    During pregnancy
    At the time of delivery
    Through breast-feeding.
    However, there are interventions to reduce the risk of transmission to the baby during pregnancy and birth. These include:

    Taking treatment so that viral load is undetectable by the time of delivery
    Giving the baby a course of treatment for the first 4 weeks of life.
    .

    Is it an ignorant choice?

    This is not an ignorant choice. Far more sero-different couples have children naturally than from using sperm washing. Fortunately, treatment now dramatically reduces the risk of transmitting HIV if this process is done carefully.

    However, it is important that both you and your partner make an informed choice. It is recommended that you discuss your options with your doctor.

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