HIV discordant couples: What is new?

Abstract

We reviewed the existing literature on the HIV discordant couples: determinants of seroconversion, reproductive options, ethical issues and future perspectives. About 10% to 20% of couples in Sub-Saharan Africa are HIV discordant. Factors influencing the risk of seroconversion in HIV discordant couples include the frequency of sexual intercourse, intercourse during menstruation, circumcision of the male partner, viral load, CD4 cell count, anal intercourse, co-existing sexually transmitted infections, stage of the disease, individual susceptibility, the use of condoms as well as antiretroviral drugs. Female positive discordant couple can have a child without risk of infecting the male partner by timed insemination. Male positive discordant couples have five options of conception: timed ovulatory intercourse, insemination of washed sperm, in vitro fertilization of washed sperm, artificial donor insemination and adoption. Timed ovulatory intercourse is cheap but carries greater risk of HIV transmission (4% cumulative risk), while the use of washed sperm is safer (risk <0.1%), but expensive and conception rate is low. Future perspectives are geared towards developing an HIV vaccine to raise the levels of killer T-cells or developing a coreceptor antagonist (CCR5 or CXCR4) to inhibit the binding of the virus at the cell surface.

Keywords: HIV-discordant couples, seroconversion, conception

Clinics in Mother and Child Health Vol. 2(1) 2005: 275-281