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I SIMPOSIO INTERNACIONAL de REPRODUCCION y HIV

I SIMPOSIO INTERNACIONAL de REPRODUCCION y HIV. CONCEPTS AND DATA FOR THE PRESS Dr Augusto E Semprini University of Milan & University College of London Dr Sergio Pasqualini Halitus Instituto Medico. The Problem: HIV in Semen. SEXUAL TRANSMISSION OF HIV. Sexual contact. -. +.

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I SIMPOSIO INTERNACIONAL de REPRODUCCION y HIV

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  1. I SIMPOSIO INTERNACIONAL de REPRODUCCION y HIV CONCEPTS AND DATA FOR THE PRESS Dr Augusto E Semprini University of Milan & University College of London Dr Sergio Pasqualini Halitus Instituto Medico

  2. The Problem: HIV in Semen

  3. SEXUAL TRANSMISSION OF HIV Sexual contact - + Infectivity Susceptibility

  4. DISCLOSURE OF HIV INFECTION DIAGNOSIS FEARS OF: DISABILITY AND DEATH SOCIAL OUTCASTING PROBLEMS WITH PROFESSIONAL LIFE LIMITATIONS IN PERSONAL LIFE BEING UNABLE TO HAVE A HEALTHY CHILD

  5. COUPLES WITH HIV Man with HIV & uninfected woman Woman with HIV & uninfected man Both partners with HIV (same viral strain) Both partners with HIV (different viral strains)

  6. REPRODUCTION AND HIV REPRODUCTIVE COUNSELLING & REPRODUCTIVE ASSISTANCE

  7. EUROPE 2001 IN THE EU THERE ARE PROBABLY 250.000 TO 500.000 INDIVIDUALS AGED BETWEEN 19 AND 34 YEARS WHO ARE INFECTED WITH HIV THERE MAY BE 200.000 TO 400.000 UNINFECTED PARTNERS AT RISK OF SEXUAL ACQUISITION OF HIV ACCORDING TO THE RATE OF SEXUAL AND VERTICAL TRANSMISSION, THERE MAY BE 30.000 TO 4.000 UNBORN INFANTS AT RISK OF ACQUISITION OF HIV FROM THE INFECTED MOTHER

  8. COUPLES WITH HIV In Europe most cases of infection with HIV derive from the use of intravenous drugs Drug use is a prevalently male behaviour (male to female ratio 4/1) Most male drug users are heterosexual (> 95%) Young uninfected females are at risk of acquiring HIV from these HIV-infected males

  9. COUPLES WITH HIV Women at highest risk of sexual acquisition of HIV are the habitual partners of HIV-infected males In Italy three out of four new cases of heterosexual transmission of HIV are females Less than 50% of HIV-discordant couples regularly recur to condom protected intercourse HIV-discordant couples should be motivated to avoid any risk of infection for the healthy partner

  10. ARE THE REPRODUCTIVE RIGHTS OF PEOPLE INFECTED WITH HIV RESPECTED ? THERE IS A NUMBER OF TRANSMISSIBILE CONDITIONS THAT ARE NOT REGARDED AS A REASON TO DISCOURAGE PROSPECTIVE PARENTS OF POTENTIALLY AFFECTED CHILDREN FROM TRYING FOR A PREGNANCY, IS IT THE SAME FOR HIV ?

  11. GOALS OF REPRODUCTIVE COUNSELLING TO HIV DISCORDANT COUPLES OFFER NON-JUDGMENTAL UNBIASED INFORMATION TO LIMIT THE RISK OF TRANSMITTING THE INFECTION TO THE UNINFECTED PARTNER AND TO THE INFANT HELP TO REDUCE THE RISK OF TOXIC CONSEQUNECES OF ANTIRETROVIRAL THERAPY TO THE OFFSPRING

  12. SECONDARY GOALS OF REPRODUCTIVE COUNSELLING TO HIV DISCORDANT COUPLES HELP THE INDIVIDUAL WITH HIV TO ELABORATE ITS DESIRE OF PARENTHOOD REINFORCE THE BENEFITS OF AVODING SEXUAL TRANSMISSION OF HIV TO THE UNINFECTED PARTNER BEFORE AND AFTER PREGNANCY

  13. WHAT ABOUT REPRODUCTIVE ASSISTANCE ?

  14. REMOVAL OF p18 IMMUNOREACTIVE CELLS FROM THE SEMEN OF HTLV-III/LAV SEROPOSITIVE MENAugusto E Semprini, A Vucetich, E Morandi, CL Parravicini, G Pardi and AE Beer. Colloque INSERM, Vol. 154, 1987, pp 462 A cytospin preparation of washed spermatozoa, supernatant and the second fraction of the ejaculate were chloroform-acetone fixed and tested against a monoclonal anti-p18 antibody by immunoperoxidase technique. Washed sperm of seropositive and seronegative men was non-reactive, while many mononuclear cells and those in the second fraction of seropostive males were strongly reactive. Experiments are under way to test the possibility of safe intrauterine insemination with processed semen of HIV-positive men desiring a child.

  15. Gradiente Migration Lavado Wash, 1/8 PCR 45% 90% LAVADO DEL SEMENSemprini et al. The Lancet, 27 November 1992 l Dilucion al final del procedimiento: 4 x 106

  16. INSEMINATION OF HIV-NEGATIVE WOMEN WITH PROCESSED SEMEN OF HIV-POSITIVE PARTNERS 85 HIV-discordant couples were screened for fertility; 29 women were found suitable for a timed insemination course with the processed semen of their HIV-positive partner. None of the inseminated women seroconverted and 17 pregnancies were achieved in 15 women. All 10 infants born to these mothers remain HIV seronegative. (Semprini et al. - Lancet 1992; 340: 1317-19)

  17. Insemination of HIV-negative women with processed semen of HIV-positive partners(Brian R Edlin and Scott D Holmberg Lancet, February 27 1993) Dr Semprini et al. (Lancet, November 1992) conclude that the lack of HIV transmission during their artificial insemination attempt in HIV-discordant couples is “reassuring” and suggest that this outcome is used in counselling such couples to “give them hope of having healthy babies”. We are concerned that their conclusions may be overstated and could mean that physicians may provide false hope to such couples.

  18. ETHICAL ASPECTS OF THE INSEMINATION OF HIV-NEGATIVE WOMEN WITH PROCESSED SEMEN OF HIV-POSITIVE PARTNERSC. La Vecchia, Human Reproduction, Vol. III, n. 3, 1993 “Nowadays the ethical aspects of medicine are complex. It is surprising how this may lead to less stringent criteria for judgement of ethical aspects by the doctors themselves, who in some case may even disregard the basic principle that in no case the life of a healthy individual should be threatened by a medical intervention. An example of this uncertainty and confusion is a recent report of the utilisation of intrauterine insemination with processed semen of HIV-positive partners for HIV-negative women.”

  19. SPECIAL CONSIDERATIONS REARDING HIV AND ASSISTED REPRODUCTIVE TECHNOLOGIESAmericanSociety for Reproductive MedicineFertility and Sterility Vol. 62, No. 5, November 1994USE OF SEMEN FROM HIV-POSITIVE PARTNERS FOR INSEMINATION OF SERONEGATIVE WOMEN PARTNERS“The Committee recommends that the physician counsel the couple regarding the risks to the woman and offspring through homologous insemination by any means and that the couple consider the options of donor insemination, adoption, or child-free living.”

  20. SPECIAL CONSIDERATIONS REARDING HIV AND ASSISTED REPRODUCTIVE TECHNOLOGIESAmericanSociety for Reproductive MedicineFertility and Sterility Vol. 62, No.5, November 1994 HIV TESTING FOR COUPLES CONTEMPLATING ART“While proceeding with ART after a positive HIV test is not necessarily unethical, the Commitee considers HIVinfection a serious contraindication to treatment”

  21. Natural conception in HIV-negative women with HIV- infected partnersL Mandelbrot, I Heard, E Henrion-Geant, R Henrion (Lancet 1997; 349: 850) We followed 104 consecutive pregnancies in 92 HIV-negative women with HIV-positive partners. Couples were advised to pinpoint ovulation in order to reduce possible exposure. Seroconversion was observed in two women at 7 months of pregnancy and in two others post partum.Some authors advocate intrauterine insemination with semen from the HIV-infected males, but the risk of this must be measured against the low background risk of natural conception. Stringent standard of safety must be required before inseminating potentially infected semen.

  22. PROBLEMS IN REPRODUCTIVE ASSISTANCE TO COUPLES WITH HIV WHICH PROCESSING METHOD ? WHICH HIV TESTING FOR SPERMATOZOA? WHICH CENTERS FOR ASSISTANCE? WHO PAYS ? HOW TO TREAT FERTILE COUPLES ? HOW TO TREAT INFERTILE COUPLES ? WHICH SEROLOGICAL FOLLOW-UP ?

  23. A NETWORK OF CENTERS PROVIDING REPRODUCTIVE ASSISTANCE TO COUPLES WITH HIV COMMUNICATION BETWEEN CENTERS EXCHANGE OF INFORMATION OPTIMIZATION OF RESOURCES MONITORING OF THE REPRODUCTIVE DESIRE AND NEEDS OF INDIVIDUALS AND COUPLES WITH HIV

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