TORONTO — A significant proportion of HIV-positive women of child-bearing age want to become pregnant at some point in the future, a new study shows, although extra care is needed to prevent transmission of the virus to their babies.
The findings, to be published online Monday by the open access journal PLoS One, point to the need for more services and support for these women so they can have healthy children, researchers say.
The study focused on women in Ontario, and found that 69 per cent of those who responded to a detailed questionnaire expressed a desire to have a baby, while 57 per cent said they actually intend to become pregnant.
Dr. Mona Loutfy, an infectious disease specialist at Women’s College Hospital in Toronto who sees a lot of HIV-positive patients, and her colleagues recruited 490 women from 38 sites across Ontario to complete the survey between October 2007 and April 2009.
“When I was seeing my patients a lot of them were saying that they were interested in pregnancy,” she said in an interview.
“They weren’t being supported either by their family doctors or other doctors, or by the system, including fertility clinics.”
When HIV-AIDS appeared on the scene in North America in the 1980s, life expectancy for those afflicted was short and most HIV-positive women were focused on survival, not contemplating becoming pregnant.
That’s all changed and Loutfy noted that HIV can be “very well managed” today.
“We have 25 anti-HIV drugs, and if we use three of them in combination and the patients take their drugs and don’t miss pills, their life expectancy is now said to be similar to the general population,” she said.
“If a woman’s HIV-positive, we can give her the same drugs and ask her to not breastfeed and the baby has less than one per cent chance of getting infected with HIV.”
Studies involving hundreds of thousands of babies born to HIV-positive women taking antiretroviral drugs in the United States and France found that they had no problems compared to the general population, Loutfy said.
“So putting all that together, I think we’re at a point now where we can support HIV-positive women and men and couples with their pregnancy planning desires.”
A few years ago in British Columbia, a similar survey found only about 30 per cent of HIV-positive women were interested in pregnancy, Loutfy said.
She attributes the higher Ontario numbers to a different demographic that includes many immigrants from Africa and the Caribbean.
“They’re taking their medications, they’re working, while in British Columbia they have more of an intravenous drug-using population and an aboriginal population that gets HIV,” she explained.
There are numerous stumbling blocks for HIV-positive women who wish to become pregnant, according to Dr. Deborah Money, executive director of the Women’s Health Research Institute in British Columbia, and an expert in viral pathogens in women and pregnancy.
“In many cases it’s family members or friends, who if they share that desire with them, are aghast that they would think about having a baby when they have HIV — usually aghast from a position of not understanding what can be done, but there’s often lack of support,” she said.
“And then the medical community, depending on who they connect with, to say I’m positive and I’d like to have a baby, they may not get a positive response, or the right advice as to what can happen or what can be done.”
She said about 200 babies are born each year in Canada to HIV-positive women.
Fertility clinics are only starting to become comfortable in dealing with HIV-positive couples, Money noted, yet they can play a key role in the conception process if one partner is HIV-positive and the other needs to be protected from the virus.
If just the woman is HIV-positive, a syringe or “turkey baster” method can be used for insemination, according to Loutfy, and this can be done at home or with the assistance of a fertility clinic.
Dr. Matt Gysler, medical director of the ISIS Regional Fertility Centre in Mississauga, Ont., said that if a man is HIV-positive, he needs drug therapy to bring the viral count down, and a special technique is used to separate the sperm from fluid so that it’s likely to be non-infectious for insemination. These sperm preparations can cost between $200 and $400, he noted.
“Many of our HIV-positive patients are recent immigrants, some of them are not financially well-to-do ... my opinion is that all fertility treatments should be covered,” he said.
“It’s very tough to sit in front of somebody who just can’t afford it.”
It was an “uphill battle” to convince his partners and lab and clinic staff to start taking HIV-positive patients three or four years ago because they feared contracting the virus or that other patients would walk out, he said.
But he won that battle, and now HIV-positive patients even travel from Montreal because they’ve had trouble finding clinics at home to serve them.
“There is a certain amount of fear and the need to set up procedures to deal with infectious patients,” he said. “Fundamentally, you just have to practise excellence in terms of contamination prevention.”
Loutfy said she surveyed 23 of 28 clinics registered with the Canadian Fertility and Andrology Society, and found about half were willing to see HIV-positive patients.
However, she found that only six of the 23 clinics offered the “sperm washing” technique described by Gysler.