Women facing HIV. Key question on women with HIV infection: Italian consensus workshop.
The number of women who learn of their HIV seropositivity and still want to have a child is growing. If the woman is HIV seropositive, pregnancy is not advised, but it is difficult if not impossible to prevent a young woman from a having wanted child. No rational argument can suppress this desire that the life-threatening illness exacerbates. The counselor must consider the clinical and immune status of the mother, the serostatus and health status of the partner, and the likelihood of family members raising the child. If the woman is HIV seronegative and her partner is HIV seropositive, the counselor must first make sure that the women does not seroconvert and that her desire for a child is real. Then the counselor must evaluate the partner's clinical and immune status. The risk of HIV transmission to the woman increases with the degree of immune suppression of the partner. It is also important to determine the stability of the discordant couple because about 33% separate after childbirth. It is only after having analyzed all these elements that the counselor and the couple can consider one of the proposed solutions. Since techniques of sperm decontamination having not yet been established, the decision is boiled down to extreme solutions: artificial insemination with sperm from an HIV negative donor or, after a spermogram and hysterography, the natural method involving intercourse only during successive periods of ovulation. The partner needs to take zidovudine to reduce the amount of sperm ejaculated. In case of pregnancy, it is necessary to recognize seroconversion, an indication for AZT. ELISA and studies on p24 antigenemia must be conducted each month of the pregnant woman. Couples must continue to use condoms after the delivery because a seroconversion would nullify all earlier efforts. Breast feeding can transmit HIV to the infant. Professional guidelines forbid tubal infertility surgery and in vitro fertilization in couples where the woman or man is HIV infected. The opinion of the French National Ethics Commission will be sought on less invasive infertility therapy.