Australian Fertility Specialists Agree to Grant HIV-Positive Women Access to IVF

A standards committee at Monash In-Vitro Fertilization center in Melbourne, Australia, agreed yesterday "in principle" to permit HIV-positive women to receive fertility treatment to become pregnant, Agence France-Presse reports. The committee made its decision after an unidentified woman with HIV appealed for access to treatment so that she could conceive without the risk of infecting her partner. Monash IVF Medical Director Gab Kovacs said that new research showing a mother-to-child HIV risk reduction from 25% to 2% with the use of antiretrovirals was important in the specialists' decision, but they agreed to "assess applications on a patient-by-patient basis." He said, "In principle it will be a decision based on [clinical information submitted by] the patient's infectious diseases doctor." The HIV-positive woman's eggs will be extracted after she is treated with drugs to minimize the viral load in her blood, then she will continue to be treated to "minimize any infection to the baby in utero," Kovacs said (Agence France-Presse, 8/13). Sydney Children's Hospital pediatric specialist Dr. John Ziegler said that due to the "combination of three strategies: drugs, Caesarean births and bottle feeding," there have been no reported cases of vertical transmission in several years (Davies/Noonan, Sydney Morning Herald, 8/13).

Some Critics Say Procedure 'Illegal'
The Victoria State AIDS Council said it was time fertility treatment was performed for HIV-positive patients, but the decision has its share of critics. Leading IVF specialist Alan Trounson said he considered the 2% risk of child infection "too high" for the procedure to be approved (Agence France-Presse, 8/13). Helen Szoke, head of Victoria's Infertility Treatment Authority, said that the procedure may be illegal for HIV-positive patients: "There is a provision [in state laws barring] people who run the risk of a genetic abnormality, or a disease being transmitted to the unborn child, to use reproductive techniques."

HIV-Positive Men Allowed to Use IVF to Father Children
Although Monash IVF has never assisted an HIV-positive woman with pregnancy, the clinic has treated two couples in which the men were HIV-positive, with a third case pending approval. Another nine couples seeking similar treatment have approached Melbourne's Royal Women's Hospital. In this treatment, a single sperm is taken from the man, tested for HIV and then frozen and used to inseminate the woman once the sperm has tested HIV-negative (Sydney Morning Herald, 8/13). Royal Women's Hospital infertility specialist Professor Gordon Baker said, "Recent advances in HIV treatment mean that most AIDS carriers are now healthy and regard their illness as chronic rather than a life-threatening condition. The couples we are dealing with are solid citizens who desperately want to have children" (Davies, The Age, 8/13).

'Different Era' of AIDS Changed Thinking
Fertility specialists at Columbia University in New York have also used IVF and sperm injection to help HIV-positive men and uninfected wives conceive. Dr. Mark Sauer, chair of the department of obstetrics and gynecology at Columbia, told Reuters Health, "The dogma has been if you had HIV, the risk of infection in your partner and newborn is such that it is not wise to have children. ... In the days these proclamations were produced, HIV was uniformly fatal. It was a different era of HIV than we see today." While several medical groups, including the CDC and American Society of Reproductive Medicine, discourage couples with an HIV-positive partner from trying to conceive, Sauer noted that many of these couples' "reproductive drive is high. People are going to have a baby one way or another." Since Sauer began offering the technique in 1998, approximately 100 couples have undergone the procedure and 20 babies have been born, all without HIV. While the procedure is not "absolutely safe," it "reduces the risk of infection to a few cells in a million, which may be negligible." Sauer will present his data next month at the American Gynecological and Obstetrical Society's annual meeting (Schorr, Reuters Health, 8/10).