ABSTRACT
In France, a ministerial decree dated 10 May 2001 authorizes the use of assisted reproduction technologies (ART) for people infected with the human immunodeficiency virus (HIV), either to reduce the risk of transmission between partners or to treat the couple's infertility. The HIV patient must have a CD4 T lymphocyte count>200/mm(3) and a stable viral load (no increase exceeding 0.5 log(10) copies/mm(3)) between 2 samples during the 6 months preceding ART. Co-infections with hepatitis B or C must be assessed by a specialist. When the man is infected, only ART allows conception while simultaneously ensuring safe sexual relations between the couple. ART is performed with prepared spermatozoa, validated negative for HIV RNA. The particular ART method depends on the results of the couple's fertility assessment and the quantity of virus in the seminal fluid. Antiretroviral treatment is not required for ART but may be necessary if the seminal viral load is elevated. When the woman is infected, the couple must be informed about the risks of HIV transmission to the child and of toxicity to mother and fetus from the antiretroviral treatments. These risks must guide optimization of the antiretroviral treatment, which is not routine during ART but is systematic during the last trimester. Management of pregnancy planning should propose artificial insemination and rapid recourse to ART because ovarian function appears to deteriorate quickly in women with HIV. Several thousand couples in Europe have used ART without any cases of contamination reported so far. Approximately half of these couples can hope to have a child, but approximately one third decide against ART after consultation.
