Important note: Information in this article was accurate in 2000. The state of the art may have changed since the publication date.
Bangkok Post - March 22, 2000
Nusara Thaitawat
Though doctors cannot guarantee the procedure, first conducted in the Italian city of Milan, is 100% safe, the hundreds of babies born through this method since the early 1990s remain HIV-free.
Two years ago, Britain became the second country to provide this procedure.
Doctors are monitoring the three babies born during the past 18 months since the procedure became available. All three babies are HIV-negative. Dr Frances Gotch of the Department of Immunology at Chelsea and Westminster Hospital, London, said seminal plasma from HIV-positive men, which includes spermatozoid and other cells, are processed in a centrifuge.
Rapid spinning separates sperms from other cells. The cleaned sperm swim up and are collected for artificial insemination or in vitro fertilisation.
In cases where more than one artificial insemination or in vitro fertilisation is needed in older women, the sperm can be frozen, Dr Gotch said.
"No chemicals are used, the sperm washing involves separation of the sperm from other cells," she said.
The procedure, which takes about one working day, costs 50 (3,000 baht), plus the cost of artificial insemination or in vitro fertilisation.
Dr Gotch said that with triple therapy, couples who never before would even dream of having children together were exploring the possibility of starting a family.
"Before the advent of triple therapy, life expectancy was an average 8 to 9 years. Things have changed," she said.
"These are responsible couples and deserve to be helped. It's also a right for the women who want to have children with their husband or partner even if they are HIV-positive," she said.
The issue came up during talks on mother-to-child transmission on the second day of the week-long international conference on HIV vaccines, organised by Mahidol University and the Ministry of Public Health.
Dr Prapha Phanuphak of the Faculty of Medicine, Chulalongkorn University, questioned the ethics in a situation where either one or both HIV-positive partners seek artificial insemination or in vitro fertilisation. Dr Gotch said it was a big ethical question in the UK and doctors were asked to prove it was safe. "Of course we can't guarantee, it's called risk reduction-HIV below a level of detection," she said.
But the story is different when it is the prospective mother who is HIV-positive, especially in developing countries, where socio-economic considerations seem to take priority over the wishes of couples to have children.
The fear is not only that the children born of HIV-positive mothers could be infected but also the prospect of them becoming orphaned.
The recommendation in the UK is for HIV-positive women to undertake triple therapy. In Thailand, because of the prohibitive costs of drugs, a regimen of AZT is recommended for women in the final stages of pregnancy and for newborns for a few days after birth.
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