F3/3 - MULTIDISCIPLINARY MANAGEMENT OF HIV AND/OR HCV INFECTED COUPLES WISHING TO HAVE CHILDREN WITH LESSER RISK OF VIRAL TRANSMISSION : ASSISTED MEDICAL PROCREATION (AMP) FOR HIV -1 OR HCV SERODIFFERENT COUPLES

9^TH EUROPEAN AIDS CONFERENCE (EACS)
1^st EACS RESISTANCE & PHARMACOLOGY WORKSHOP

October 25 - 29, 2003 Warsaw, Poland

14.2 Perinatal Transmission

F3/3 - MULTIDISCIPLINARY MANAGEMENT OF HIV AND/OR HCV INFECTED COUPLES WISHING TO HAVE CHILDREN WITH LESSER RISK OF VIRAL TRANSMISSION : ASSISTED MEDICAL PROCREATION (AMP) FOR HIV -1 OR HCV SERODIFFERENT COUPLES

* Tubiana R.¹, Lefebvre G.², Marcellin A.G.³, Rozemblum O.⁴, Simon A.⁵, Thabut D.⁶, Ghosn J.¹, Mbida L.⁷, Vauthier D.², Thibault V.³, Dominguez S.¹, Bonmarchand M.⁶, Pauchard M.¹, Katlama C.¹, De Montgolfier I.⁸, Poirot C.⁷

(1) Infectious diseases,² Obstetrics and Gynecology,³ Virology,⁴ Psychiatry,⁵ Internal medecine,⁶ Hepatology,⁷ biologie de la reproduction,⁸ Pediatry Hopital Pitié Salpétrière Paris, France

Since May 2001, AMP in HIV or HCV infection is allowed in France.

To respond to the increasing number of serodifferent couples whishing to have children with a lesser risk, we set up a multidisciplinary management. In addition to AMP procedures, each specialist perform a specific evaluation before collaborative decisions. For HIV-1 or HCV infected men, HIV-RNA and DNA highly sensitive( 5 copies/106 SPZ ) or HCV -RNA PCR were performed on semen samples, the goal being to obtain spermatozoal final fraction (ff) isolated by density gradient, free of viruses. We recommand antiretroviral therapy for patients with plasma-HIV > 10.000 copies /ml .

Between may 2002 and may 2003, 110 couples did seek for information and 85 started AMP : 24 HIV-infected women , 54 serodifferent couples with a man HIV and/or HCV and 7 with both man and woman infected .

Women median age was 36 years ( range: 26-45). 70 samples from 38 patients, 21/38 HIV, 13/38 HIV+HCV and 4 HCV infected were analyzed. The ff was positive for HIV-RNA and DNA in 5 and 5 patients respectively. All but one patients had undetectable blood HIV- RNA. HCV- RNA was positive in 6/17 patients in seminal plasma but in only one for the ff. 18 couples started Intrauterine insemination with 9 pregnancies for 44 cycles and 8 performed in vitro fertilisation or Intracytoplasmic Sperm Injection (ICSI) with 2 pregnancies. The first baby is expected in august 2003.

Presenting Author: MD Roland TUBIANA, Infectious diseases Department Pitié Salpétrière Hospital, bd de l'hopital, 75013, PARIS, France, Phone: 00.33.1.42.16.01.71

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