Today, men and women living with HIV can safely become parents. To mark World Aids Day, Carole Gilling-Smith, medical director of the Agora Clinic in Hove, looks at the medical advances that have made this possible
In the 80s and 90s, HIV was regarded as a terminal disease. Infected men and women were advised to have protected intercourse and not to attempt to have a child for fear of passing the virus on. Then, around 20 years ago, as a result of new highly active antiretroviral therapy (HAART), HIV was redefined as a chronic (long term) disease. By this time, men and women living with the condition were enjoying good life expectancy, similar to those living with diabetes, and there was no longer any reason to deny them the chance of having a family if it could be done safely. The real issue was preventing the transmission of infected sperm to an uninfected partner.
From sperm washing…
In the late 1990s, I was privileged to lead the fertility team in the UK that carried out pioneering work to help HIV positive men become fathers safely, using a technique known as ‘sperm washing’. It enabled sperm from an HIV positive man to be processed in such a way that it was ‘free of HIV’ and then used, via intrauterine insemination or IVF techniques, to help a couple conceive without the risk of infecting either the woman or their child.
One of my patients, Perry Evans, had contracted HIV in the early 1980s through an infected blood transfusion. Using the sperm washing technique, Perry and his wife Heather conceived a son, Isaac. Shortly after this Perry developed cancer (which can occur more frequently in patients with HIV) but we were able to wash and freeze his sperm before he started chemotherapy. Thankfully, once he had completed his treatment, Perry and Heather were able to use his frozen sperm to conceive their beautiful healthy daughter, Cerian.
“As parents, we are so indebted to the work of Carole and her team,” said Perry. “You live your life again through your children, they touch your heart, and it’s a beautiful experience. Sometimes I look back on the day I was told I’d never have a family, and the rollercoaster experience that resulted in our family, and I’m so thankful for the work that has been done – and continues to be done – in this country.”
…to natural conception
During the past ten years, there’s been a further positive twist to the whole HIV story – something no one could have predicted. In 2008, a scientific publication from Switzerland proposed that men and women living with HIV should no longer be regarded as infectious if they’d been on HAART for at least six months and the virus could no longer be measured in their blood. Natural conception was now a real possibility.
In July 2016 the ‘U = U’ campaign was launched. This is a simple but hugely important campaign based on solid scientific evidence. U = U stands for Undetectable virus in the blood (through HAART) which means it is Untransmittable (so cannot be passed on sexually to others). It’s been endorsed by the over 500 scientific bodies worldwide, including the Centers for Disease Control in the USA and the British HIV Association. The campaign has already been successful in influencing public opinion and reducing the stigma previously associated with HIV.
Today, men and women living with HIV can have long, healthy and fulfilling lives, conceiving children naturally if they are on HAART – and not having to worry about passing on the virus through sexual contact. And, if they suffer from infertility, they can be treated using IVF in the same way as someone who is HIV negative. Sperm washing is rarely used, unless a patient does not respond to HAART.
There is, however, still more work to be done for those living with HIV who wish to be egg or sperm donors to a known surrogate. In most parts of the world, despite HAART and the ‘U = U’ campaign, regulatory bodies (such as the HFEA in the UK) do not permit donors to be infected with HIV. One day soon I believe it will be possible; it’s just a matter time for the regulatory bodies to understand the real impact that HAART has had on HIV.
World Aids Day is organised by the Terrence Higgins Trust with the aim of raising funds to tackle stigma and support people living with HIV.
To find out more about the wonderful Agora Clinic, click here