Williams Christopher D, Finnerty James J, Newberry Yvonne G, West Rebecca W, Thomas Theodore S, Pinkerton JoAnn V
Department of Obstetrics and Gynecology, University of Virginia School of Medicine, Charlottesville, VA 22903, USA.
Am J Obstet Gynecol. 2003 Aug;189(2):333-41. doi: 10.1067/s0002-9378(03)00676-8.
There has been a transformation in the treatment of human immunodeficiency virus from the treatment of complications that define acquired immune deficiency syndrome to the maintenance of long-term health, with an expanding number of antiretroviral medications. Because human immunodeficiency virus infection now is considered to be a chronic disease, couples will be seen in greater numbers for preconception counseling. The ethical and legal implications, including the relevance of the Americans with Disability Act, are complex but support the assistance with reproduction of couples who are affected by human immunodeficiency virus in many instances. All couples who are affected by human immunodeficiency virus, whether fertile or infertile, who want to have genetically related offspring should be seen preconceptionally for counseling and testing. Intensive education involves a multidisciplinary approach to ensure that a couple is fully informed. Determination of whether to offer treatment should be based on the same criteria that are applied to couples who are affected by other chronic diseases. Medical treatment is dependent on the unique circumstances of each couple. In general, the affected partner(s) should be treated aggressively with antiretrovirals and then serum; if applicable, semen testing is required to document undetectable concentrations of human immunodeficiency virus (<50-100 copies/mL).
随着抗逆转录病毒药物数量的不断增加，人类免疫缺陷病毒的治疗已从治疗获得性免疫缺陷综合征所定义的并发症转变为维持长期健康。由于现在认为人类免疫缺陷病毒感染是一种慢性病，将会有更多的夫妇前来接受孕前咨询。包括《美国残疾人法案》相关性在内的伦理和法律问题很复杂，但在许多情况下支持为受人类免疫缺陷病毒影响的夫妇提供生育帮助。所有受人类免疫缺陷病毒影响的夫妇，无论有生育能力还是无生育能力，若想要有与自己有基因关系的后代，都应在孕前接受咨询和检测。强化教育采用多学科方法，以确保夫妇充分了解情况。决定是否提供治疗应基于适用于受其他慢性病影响夫妇的相同标准。医疗治疗取决于每对夫妇的独特情况。一般来说，受影响的一方应积极接受抗逆转录病毒治疗，然后进行血清检测；如果适用，需要进行精液检测以证明人类免疫缺陷病毒浓度低于检测下限（<50-100拷贝/毫升）。
