American journal of obstetrics and gynecology 2017 02 13() pii 10.1016/j.ajog.2017.02.012
Special considerations must be taken when patients with human immunodeficiency virus (HIV), Hepatitis B, or Hepatitis C desire to achieve pregnancy. Patients with chronic viral illnesses desire children at rates similar to the general population, and options are available to decrease both vertical transmission and viral transmission between partners. Preconception counseling or consultation with fertility specialists is imperative in patients with HIV, Hepatitis B, and Hepatitis C so that reproductive goals can be addressed and optimized. In couples where one partner has HIV, the use of highly active antiretroviral therapy (HAART) or pre-exposure prophylaxis (PrEP) can significantly reduce the risk of transmission between serodiscordant partners. The use of density gradient sperm washing techniques and intrauterine insemination (IUI) or in vitro fertilization (IVF) results in an apparent lack of transmission of HIV between partners when the male partner is HIV-positive. Vertical transmission of HIV from mother to child can be reduced by use of HAART regimens throughout pregnancy or by Cesarean delivery in the setting of high maternal viral load. Transmission of Hepatitis B between partners can be eliminated by vaccinating the uninfected partner. Vertical transmission from a Hepatitis B infected mother to a child can be reduced by vaccinating neonates with the standard Hepatitis B vaccine series as well as Hepatitis B immune globulin. Recent data has shown the antiviral medication tenofovir to be an effective way to reduce vertical transmission in the setting of high maternal viral load or the presence of HBeAg. There are multiple antiviral medications available to treat chronic Hepatitis C, although access to these medications is often limited by cost. Similar to HIV-positive patients, in settings where the male partner is infected with Hepatitis C, density gradient sperm washing can be utilized prior to IUI or IVF to reduce transmission of Hepatitis C between partners. No safe and effective method exists to reduce vertical transmission of Hepatitis C once a woman becomes pregnant, highlighting the importance of treatment of Hepatitis C prior to pregnancy.