Barreiro Pablo, Castilla José Antonio, Labarga Pablo, Soriano Vincent
Department of Infectious Diseases, Hospital Carlos III, Calle Sinesio Delgado 10, 28029 Madrid, Spain.
Hum Reprod. 2007 Sep;22(9):2353-8. doi: 10.1093/humrep/dem226. Epub 2007 Jul 19.
The remarkable reduction in HIV-related morbidity and mortality as a consequence of the widespread use of highly active antiretroviral therapy (HAART) has led to a growing number of HIV-infected persons and their partners requesting counselling regarding the chances of reproduction. A thoughtful medical evaluation of the couple, which should entail HIV status, screening for genital infections and fertile potential, is needed before considering any reproductive attempt. Given that both sexual and perinatal transmission of HIV is directly correlated with the level of viral replication, being almost negligible in patients with undetectable viremia, HAART should be given to the infected partner to minimize the risk of transmission. Assisted reproduction after 'sperm washing' may further reduce the chances of infection, although this is not within reach or desire for a significant number of HIV-serodiscordant couples. From our perspective, natural conception could now be considered a possible alternative for HIV-serodiscordant couples, as long as complete suppression of viremia with HAART is achieved in the infected partner. The objective of this paper is to propose a protocol that may minimize risks in HIV-discordant couples that have opted for natural conception.
由于广泛使用高效抗逆转录病毒疗法（HAART），与艾滋病相关的发病率和死亡率显著降低，这使得越来越多的艾滋病毒感染者及其伴侣要求就生育机会进行咨询。在考虑任何生育尝试之前，需要对夫妻进行全面的医学评估，包括艾滋病毒感染状况、生殖器感染筛查以及生育潜力评估。鉴于艾滋病毒的性传播和围产期传播都与病毒复制水平直接相关，在病毒血症检测不到的患者中这种传播几乎可以忽略不计，因此应给予感染伴侣HAART以降低传播风险。“精子清洗”后的辅助生殖可能会进一步降低感染几率，不过对于大量艾滋病毒血清学不一致的夫妻来说，这并非他们能够做到或期望的。从我们的角度来看，只要感染伴侣通过HAART实现了病毒血症的完全抑制，自然受孕现在可以被视为艾滋病毒血清学不一致夫妻的一种可能选择。本文的目的是提出一种方案，该方案可以将选择自然受孕的艾滋病毒不一致夫妻的风险降至最低。
