United Press International - July 1, 2002
Katrina Woznicki, UPI Science News

Janice Copeland, of the Genesis Fertility Center in Vancouver, B.C., presented research indicating effective anti-retroviral drugs, combined in an aggressive cocktail of medications, have effectively suppressed the human immunodeficiency virus -- the virus that causes AIDS -- converting a disease that once was a death sentence into a chronic condition. This dramatic shift during the last decade, Copeland said, has permitted many young HIV patients to consider having their own biological children instead of adopting.

"These are uncharted waters and we're just beginning to understand the issues," Copeland said.

To illustrate this growing interest among HIV patients, Pietro Vernazza, an HIV specialist from the Infectious Diseases division at Cantonal Hospital in St. Gallen, Switzerland, presented results from a survey of 160 couples. In cases where at least one partner had been infected, 53 percent nevertheless expressed a desire to conceive and 24 percent admitted not using condoms regularly.

In the United States alone, there are an estimated 793,000 AIDS cases. More than half of patients are between ages 20 and 39, the peak of their reproductive years, Copeland said. Twenty-three percent of new HIV/AIDS cases are women, she added, and heterosexual sex has become one of the top causes of HIV transmission.

Despite significant improvements in life expectancy among Americans infected with HIV, there are no guidelines for fertility clinics to treat this population, Copeland said. Although some HIV patients can conceive naturally, reproductive technologies might be able to reduce the risks of transmission from an HIV-positive partner to an uninfected partner and also minimize transmission risks to the baby. Transmission risks are higher, Copeland said, if the woman is HIV positive.

Whether artificial insemination, in vitro fertilization or other methods work best among HIV patients remains to be determined and depend on the stage of the individual's disease, she explained. Copeland said fertility specialists are facing "reproductive freedom" questions -- whether allowing HIV-infected individuals to have biological children is unacceptable because of the child's risks of exposure and becoming orphaned.

Copeland said for an HIV-positive woman on an aggressive anti-retroviral therapy, an elective Cesarean section -- removing the baby via an incision in the abdomen instead of through the birth canal, where infection risk is greater -- can reduce infection to as little as 2 percent. Breast-feeding, on the other hand, increases transmission risk. Any HIV seeking fertility treatment will need to be counseled about such risks, Copeland said, including risks after childbirth.

Twelve years ago, the Centers for Disease Control and Prevention recommended against insemination from HIV-infected men. That, too, could change as anti-retroviral drugs -- HIV is a rare type of virus called a retrovirus -- and reproductive technologies became more sophisticated. Vernazza presented research showing scientists working to extract healthy sperm from HIV-infected patients whose virus levels are practically undetectable from aggressive drug therapies.

This technique of separating the sperm from the virus is currently being tested at Brigham and Women's Hospital in Boston, Vernazza said, though there still are risks that separated sperm could become contaminated with HIV or perhaps another organism that could reduce its ability to fertilize an egg.

"Are we ready to offer this service?" Vernazza asked. Scientists could be approaching "a stage here ... where we can actually offer this expertise."

That issue may remain problematic. Despite medical advances, Copeland said, surveys of fertility clinicians suggest a reluctance to treat HIV patients who want to become biological parents. Fertility specialists expressed concern about HIV transmission from patient to doctor. They also questioned whether healthy embryos from other couples sharing the same laboratory could be placed at risk.

Despite the strides made in both AIDS and infertility treatments, many people living with HIV who want children might not realize the law could be on their side, Copeland added. On June 25, 1998, the U.S. Supreme Court ruled in the case Bragdon vs. Abbott that an HIV positive patient who shows no signs of AIDS is protected under the 1990 Americans with Disabilities Act, and this protection could extend to child-bearing. The case was a victory for HIV patient Abbott who was denied dental treatment by Bragdon, a dentist in Maine.

When asked why HIV couples do not legally challenge fertility clinics if they are denied treatment, Copeland told United Press International many HIV patients probably do not realize they could have a legal case. That might change, she said. "I believe in the next couple of years, much more will be offered to these couples."

Joap Dorr, a gynecologist in The Hague, the Netherlands, recommended guidelines be established on these issues. Fertility specialists "have many questions about this subject," he told UPI. There is a growing interest among European doctors to offer some kind of fertility options to HIV patients, but the United States appears to be shying away from that opportunity, he commented.

"I think it's unfair," not to treat HIV patients, "because life expectancy has changed dramatically these last few years," Dorr said. "It would be unfair not to give treatment." Eventually, HIV patients will demand it and "there will be more (HIV patients seeking fertility treatment) in the future."

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