As the UK's largest HIV, human immunodeficiency virus, charity, Terrence Higgins Trust
warmly welcomes the decision by the National Institute for Health and Clinical
Excellence (NICE) last month to consult on an updated version of its fertility
guideline. The new approach outlined by NICE holds the potential to transform
fertility services for men and women living with or affected by HIV in the UK
who want to become parents, and goes a long way towards demystifying some
crucial issues surrounding HIV, fertility and conception.
For the first time NICE recommends an approach that not only
acknowledges mother to baby transmission of HIV is preventable, but also states
clearly that natural conception is now a real possibility for couples where the
male partner is HIV positive and that this should be recommended in certain
The new guideline explains that the process of 'sperm washing',
used where the male partner is living with HIV, is no longer an essential
requirement if the man meets a number of criteria in relation to managing the
infectivity of his HIV.
The availability of Highly Active Anti-Retroviral Treatment
(HAART), which reduces the levels of the virus in the body and strengthens
immune response to infection, has revolutionised pregnancy and motherhood for
women living with HIV. Combining HAART with bottle feeding has allowed mothers
living with HIV to reduce the risk of transmission to their baby from around 26
percent to less than one percent in the last 15 years.
Sperm washing has been the only option for HIV positive men
who want to become fathers without risk to their partners. The process involves
separating sperm from seminal fluid where HIV may be present, which can then be inseminated using either intrauterine insemination or IVF.
However, recent studies and announcements by the HIV
scientific community clarifying the impact of HAART on the transmissibility of
HIV during sex, is offering men living with HIV an opportunity to conceive
naturally with their partners without risk of HIV transmission.
In 2008, a group of Swiss scientists produced a consensus
statement that concluded an HIV positive person who is taking effective HIV
medication, who has an undetectable viral load and who does not have any other
STIs (sexually transmitted infections), has only a negligible risk of passing the virus on to others. Since that
time a number of subsequent studies have been undertaken that have produced
similar results, most notably a 2011 study involving nearly 2,000 serodiscordant
couples which found a 96 percent reduction in the risk of infection through sex
where HIV treatment was being taken successfully.
NICE has shown initiative in acknowledging this scientific
consensus and has used its new guideline to recommend that sperm washing is no
longer necessary if a man is adhering to HIV medication successfully, has a low
viral load and has no other infections. In these circumstances NICE now
recommends that couples can try to conceive naturally when the woman is
ovulating and that in these circumstances the risk of transmission remains very
low. The guideline also states that it should no longer be necessary for women
to have to take post exposure prophylaxis in order to avoid infection when
trying to conceive with an HIV positive partner who is undergoing treatment.
This decision is a hugely positive one for people living with
HIV who can unfortunately still encounter confusion and lack of knowledge about
their condition within the NHS. Terrence Higgins Trust regularly supports
people who have encountered difficulties in accessing good advice around
fertility issues or who have been unable to access fertility services on the
NHS. This can be the result of inconsistencies in approach across the country,
but equally may be the result of poor knowledge or outdated views around
conception and HIV risk. The new NICE guideline offers a clear and unequivocal
approach to these issues that we certainly hope will improve the experiences of
couples living with HIV across the UK who want to conceive.
Medical advances mean that an HIV diagnosis should no longer
be a barrier to parenthood and we will be working to ensure that NICE's stance
on this issue this is broadly recognised and adopted across the NHS.
The consultation closes on 3 July.