For the first time NICE recommends an approach that not only acknowledges mother to baby transmission of HIV is preventable, but also states clearly that natural conception is now a real possibility for couples where the male partner is HIV positive and that this should be recommended in certain circumstances.
The new guideline explains that the process of 'sperm washing', used where the male partner is living with HIV, is no longer an essential requirement if the man meets a number of criteria in relation to managing the infectivity of his HIV.
The availability of Highly Active Anti-Retroviral Treatment (HAART), which reduces the levels of the virus in the body and strengthens immune response to infection, has revolutionised pregnancy and motherhood for women living with HIV. Combining HAART with bottle feeding has allowed mothers living with HIV to reduce the risk of transmission to their baby from around 26 percent to less than one percent in the last 15 years.
Sperm washing has been the only option for HIV positive men who want to become fathers without risk to their partners. The process involves separating sperm from seminal fluid where HIV may be present, which can then be inseminated using either intrauterine insemination or IVF.
However, recent studies and announcements by the HIV scientific community clarifying the impact of HAART on the transmissibility of HIV during sex, is offering men living with HIV an opportunity to conceive naturally with their partners without risk of HIV transmission.
In 2008, a group of Swiss scientists produced a consensus statement that concluded an HIV positive person who is taking effective HIV medication, who has an undetectable viral load and who does not have any other STIs (sexually transmitted infections), has only a negligible risk of passing the virus on to others. Since that time a number of subsequent studies have been undertaken that have produced similar results, most notably a 2011 study involving nearly 2,000 serodiscordant couples which found a 96 percent reduction in the risk of infection through sex where HIV treatment was being taken successfully.
NICE has shown initiative in acknowledging this scientific consensus and has used its new guideline to recommend that sperm washing is no longer necessary if a man is adhering to HIV medication successfully, has a low viral load and has no other infections. In these circumstances NICE now recommends that couples can try to conceive naturally when the woman is ovulating and that in these circumstances the risk of transmission remains very low. The guideline also states that it should no longer be necessary for women to have to take post exposure prophylaxis in order to avoid infection when trying to conceive with an HIV positive partner who is undergoing treatment.
This decision is a hugely positive one for people living with HIV who can unfortunately still encounter confusion and lack of knowledge about their condition within the NHS. Terrence Higgins Trust regularly supports people who have encountered difficulties in accessing good advice around fertility issues or who have been unable to access fertility services on the NHS. This can be the result of inconsistencies in approach across the country, but equally may be the result of poor knowledge or outdated views around conception and HIV risk. The new NICE guideline offers a clear and unequivocal approach to these issues that we certainly hope will improve the experiences of couples living with HIV across the UK who want to conceive.
Medical advances mean that an HIV diagnosis should no longer be a barrier to parenthood and we will be working to ensure that NICE's stance on this issue this is broadly recognised and adopted across the NHS.
The consultation closes on 3 July.