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Challenge: Caring for the fertility needs of HIV‐seropositive males

Background:

 40 million people are living with HIV.

 Most HIV‐infected individuals are males of reproductive age.

 At least one‐third of infected individuals wish to have a family.

 Patients require a multidisciplinary approach.

 Safe sex practice with condoms is recommended to prevent infection in the partner, and partners should talk to their doctors about pre‐exposure prophylaxis (PrEP).

 Co‐infection with hepatitis is a common comorbidity.

Management options:

 IUI in men with normal semen analysis and partners without fertility problems.

 ICSI which has highest efficacy per treatment cycle.

 Well‐timed intercourse or self‐insemination if viral load undetectable, males are compliant with HAART and women are prescribed PrEP.

 Partners should be tested following treatment and throughout pregnancy.

 Baby should be tested for HIV at delivery and 3 months postpartum.

 No prophylaxis is required in women receiving processed specimens.

Prevention:

 Sperm washing techniques separate sperm from infected seminal plasma.

 Sperm lack viral receptors and co‐receptors and are unlikely to be viral vectors.

 HIV has not been detected in aliquots obtained from properly prepared sperm specimens.