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Medically assisted procreation (MAP) provides an opportunity to become a parent without risk of contamination infected with the AIDS virus (HIV) torque evidence for the success of the team of the Cochin Hospital in Paris center Reference in this specialty, which took stock of its activities in the field, at a press conference.

Pregnancy even in the presence of the AIDS virus

This press conference intervened in the preamble to the International Day against AIDS and public debate *.

For many years, it seemed impossible for physicians to help people infected with the AIDS virus (HIV) to become parents. This attitude was due to several reasons: the fear of contaminating a seronegative woman with infected semen, the risk for a child to be HIV infected in her lap and reluctance to promote the birth of a child woman who could orphanhood in the short term.

In the late 90s, two major events have radically changed the situation:

- The development of more effective antiretroviral therapies that have dramatically improved the prospects and quality of life of people infected

- The development of techniques to control the risk of viral contamination in the MPA procedures.

Consequently, many HIV-infected couples have applied for the MPA for one or more children. In May 2001, a decree of the Minister of Health has identified the possibilities and conditions for support of assisted reproduction technique for patients with viral risk.

"This is only undertaken if the infection is controlled. The most common situation is that of discordant couples where the man is HIV-positive and HIV-negative women. In this case, insemination or in vitro fertilization is performed with sperm selected, cleaned the other components of semen and a portion of which is subject to a search of the virus. If such research is negative, sperm are then declared 'good for the MPA, "explains Prof. François Olivennes (Cochin Hospital).

"The sperm is deposited gently into a tube at the bottom which was previously set a density gradient, that is to say, a slightly viscous liquid prepared in two different densities. Then carried to a first

centrifugation for 20 minutes to allow to the various components to pass through two layers of density according to severity. then obtained a pellet consisting of a mass of sperm (usually remain only those well established and highly mobile), which is mixed in 5 ml liquid survival, "describes Dr. Emmanuel Dulioust (Cochin Hospital), told Reuters Health.

In a second step, he says, the solution undergoes a "wash" which consists of a liquid into a clean redilution followed by centrifugation, this procedure is repeated once in order to retrieve only sperm in a pellet 1 ml of fluid and to eliminate survival seminal fluid and nonspecific cells (germ cells and immature white blood cells).

"In a man with HIV, HIV is spread in the form of viral particles are in the seminal fluid, or in white blood cells, hence the need to separate from the rest of motile sperm," he explains.

The third step is to allocate sperm obtained in two stocks, one of which is frozen in the form of flakes for a AMP and the other (comprising about 1 million sperm) subjected to a virological analysis.

"Unlike the blood that remains relatively stable, the sperm is highly variable in composition, hence the need to ejaculate per ejaculate," warns Dr. Dulioust. According to him, in fact, if the risk of finding HIV in sperm becomes more important in case of high plasma load, however, any undetectable viral load does not guarantee the level of sperm that may contain more HIV than in blood.

"In case of a positive search for a man untreated, with a viral load ranging from 20 to 30,000 copies / ml, triple therapy is usually given for 3-4 months, after which the same procedure is repeated. If HIV found in sperm and detectable viral load in a patient man (much more rare situation in the candidate MPA, said the specialist), it is important to revisit therapeutic modalities, "he says. Similarly, AMP can be considered in the absence of concomitant genital infections which themselves increase the viral load.

When the woman is infected

In other cases, it is the woman who is infected by having himself contaminated or not mate. In this situation, an MPA is motivated because of infertility or non-completion of a autoinsémination or in order not to contaminate a negative partner. Strict conditions of safety and support for women are observed.

"It is essential that in women, the infection is well controlled with low or undetectable viral load and stable and satisfactory immunological status. To avoid contamination of Maternal-Fetal occurring especially in late pregnancy or during delivery, antiviral treatment is considered after the sixth month of pregnancy or optimized if already established, taking into account the risk of fetal toxicity. Cesarean section is provided in the case of elements to suspect a long process, "says Dr. Dulioust.

To date, no contamination of women (if positive partner) and children (in the case of HIV-positive mothers) were found in the AMP service Cochin hospital.

Since 1999, 778 AMP cycles were performed in total for 255 couples with HIV. They yielded 146 pregnancies and birth of 88 children.