Sexual transmission remains the most common mode of acquisition of HIV. Since the beginning of the HIV pandemic in the early 1980s, there have been no risk-free methods by which HIV-discordant couples could conceive their own biological child. Alternatives such as adoption or artificial insemination using semen from an HIV-negative donor are currently the lowest-risk options available to HIV-discordant couples in which the male is HIV positive and the female is HIV negative. A number of studies have been conducted in Europe in HIV-discordant couples undergoing insemination with sperm from HIV-positive men that had been processed using a variety of cell-washing techniques and viral testing (Semprini et al. 1992; Semprini 1999; Marina et al. 1998; Kim et al. 1999). Results of the studies performed to date show an overall lower transmission rate than would be predicted using natural conception; however, the risk of transmission may not be eliminated. There are couples in the United States, specifically within the bleeding disorders community, who may be interested in attempting conception using these or similar techniques in a responsible manner but who have few options since there are at present no controlled, well-designed protocols available to them. The choices facing these couples are few: unprotected sex, working with physicians and laboratories that may not have the requisite experience in these technically demanding tests, or giving up the idea of conceiving their own children. There is a pressing need for the scientific and medical communities in the United States to recognize the importance of this issue, to examine critically the current state of knowledge, to identify areas of needed research, and to conduct this research in a timely manner so that HIV-discordant couples may have access to controlled, scientifically sound clinical research trials.

References
Kim LU et al. Evaluation of sperm washing as a potential for reducing HIV transmission in HIV-discordant couples wishing to have children. AIDS 1999;13:645-651

Marina S et al. HIV-1 serodiscordant couples can bear healthy children after undergoing intrauterine insemination. Fertil Steril 1998;70:35-39

Semprini AE et al. Insemination of HIV-negative women with processed semen of HIV-positive partners. Lancet 1992;340:1318-1319

Semprini AE. Personal communication, 1999