Attitudes towards routine human immunodeficiency virus (HIV) screening and fertility treatment in HIV positive patients--a UK survey

Human immunodeficiency virus infection and fertility care in the United Kingdom: demand and supply

OBJECTIVE

To collect data on the demand and provision of fertility care in HIV-infected couples in the United Kingdom and data on the etiology of subfertility in this population.

DESIGN

A postal questionnaire survey and audit of causes of infertility in HIV-infected women.

SETTING

Seventy-four Human Embryology and Fertilisation Authority-registered assisted conception units (ACUs) and 294 genitourinary medicine (GUM) clinics in the United Kingdom were sent questionnaires.

PATIENT(S)

Sixty-five HIV-infected women attending the Research Clinic at the Chelsea and Westminster ACU.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Number of ACUs treating HIV-infected patients and number of GUM clinics receiving requests for referral, as well as the etiology of subfertility in HIV-infected women attending our clinic.

RESULT(S)

Response rates from ACUs and GUM clinics were 93% and 63%, respectively. Fourteen ACUs (20%) were treating HIV-infected men; of these, seven (10%) performed sperm washing, but only two (3%) tested sperm for HIV after processing, before use. Nine units (13%) treated HIV-infected women, but only three ACUs (4%) had separate laboratories for handling potentially infected gametes or embryos. Of the 15,211 patients registered in 81 GUM clinics, 4% of the men and 16% of the women had requested advice on conceiving. An audit of the Chelsea and Westminster HIV fertility clinic demonstrated a 40% prevalence of tubal factor infertility in HIV-infected women.

CONCLUSION(S)

Demand is high, and set to increase, but current suboptimal practice in some centers is placing unaffected partners and the unborn child at risk of seroconversion.

Laboratory safety during assisted reproduction in patients with blood-borne viruses

For couples where one or both partners are infected with human immunodeficiency virus or hepatitis C, the doors to receiving fertility care are opening as a result of better antiviral medication, better long-term prognosis and consequent changes in attitude. In line with this, fertility centres electing to treat couples with blood-borne viral (BBV) infection need to re-examine their policies and procedures to ensure the safety of their staff and both non-infected and infected patients during assisted reproduction treatments. At a time when the European Tissue Directive aims to introduce quality standards for assisted reproduction throughout Europe, we highlight the risks involved when treating patients with known BBV infections and argue that safety cannot be met with any certainty unless samples from such patients are handled within a separate high security laboratory or laboratory area, technically adapted to ensure minimal cross-contamination risk to uninfected gametes and embryos.

Fatherhood and HIV-positive heterosexual men

OBJECTIVES

The study of HIV and issues of reproduction is women-focused. HIV-positive men are overlooked and understudied. This study examined views on reproduction of heterosexual HIV-positive men.

METHODS

Systematic questionnaire data were gathered from HIV-positive men (n=32) attending an HIV clinic in London.

RESULTS

Heterosexual men were rarely given medical advice on reproduction (only 9.4%). Few felt fully informed (21.9%), while many felt uninformed (46.9%) or needed more information (28.1%). Over half would value fertility/fathering consultations, up-to-date information and quick referral to fertility clinics. Nearly half (43.8%) had considered having children and 37.5% had had a child prior to HIV diagnosis. HIV status affected views on fathering, and the advent of new treatments changed views in over half of the men. Almost half (41%) believed they would experience discrimination if they conceived a baby and a quarter would withhold their HIV status when attending antenatal clinics. The majority (81%) believed that a child gave meaning to life and something to live for - only 3.1% felt a child would be a burden. Most men overestimated potential vertical transmission and would value time to discuss fathering and fatherhood.

CONCLUSIONS

There are gaps in provision. The majority of men felt that children gave meaning to life and a reason to live. Reproduction issues are not raised with HIV-positive men who are uninformed and unclear where to turn for information. Fatherhood should not be shunned as an issue for all HIV-positive men.

Screening for HIV, hepatitis B and C infection in a population seeking assisted reproduction in an inner London hospital

The Human Fertilisation and Embryology Authority requires all sperm donors to be screened for human immunodeficiency virus (HIV), hepatitis B and C and their semen quarantined for six months. No guidelines exist for screening prior to in vitro fertilisation or intracytoplasmic sperm injection. We prospectively analysed the prevalence of these viruses in our patients. Screening detected one case of HIV (0.13%), four of hepatitis C (0.5%) and 14 new cases of hepatitis B (1.7%). The prevalence of hepatitis B and HIV in our antenatal population at this time was 1.4% and 0.8%, respectively. Knowledge allows measures to be taken to reduce the risk of transmission to partner, fetus, new born baby, or by cross-contamination during embryo cryostorage and enables couples to make an informed decision regarding proceeding with treatment. Detection of infection in one partner should no longer preclude fertility treatment.