1 December 2020

How do HIV and AIDS affect fertility?

Consultant Gynaecologist
Dr Mireia Galian

IVI London

 

The 1st of December marks World AIDS Day. On this day, it’s important we remind ourselves that this is still an ongoing pandemic, affecting nearly 38 million people globally every day.  In the UK alone, there are over 100,000 people living with HIV.  World AIDS Day is an opportunity to show our support for those whose lives are affected by the infection, as well as commemorate those who have died from AIDS.

We can do this in a number of ways. Firstly, it is important to raise awareness about the infection itself, by allowing more people to understand it and removing some of its common myths. In this article, we will look at the facts about HIV and AIDS. What is HIV, what is AIDS, and how are they different? What are the early symptoms, and how do you recognise them?

We will answer each of these questions, and also discuss the ways in which being HIV positive can affect fertility. Armed with the facts, you will know when you should see a doctor or a fertility specialist.

What are HIV and AIDS, and how are they different?

HIV is a virus, and it is transmittable in different ways. It is not highly infectious except in specific circumstances. AIDS is a syndrome which can develop from HIV in the absence of treatment.

Human immunodeficiency virus (HIV)

HIV damages the immune system by attacking CD4 cells, a type of white blood cell that plays a key role in the immune function, also known as T-helper cells or T cells. As the virus causes the T-helper cells to lose their protective ability, the body becomes less able to fight off infections and, over time, more vulnerable to serious diseases like cancer.

  • HIV is transmitted through bodily fluids including blood, semen, vaginal and rectal fluids and breast milk.
  • HIV is not transmittable through air, water or through casual contact such as a handshake.
  • HIV inserts itself into the DNA of the immune cells that it attacks and is therefore a lifelong condition which can be controlled, but cannot be cured at this point in time.
  • HIV is unpredictable and its pace of progression can vary according to a patient’s overall health, age, and crucially, how soon diagnosis takes place – this makes the timing of treatment very important.
  • Without treatment, HIV continues to replicate itself, damaging an increasing number of CD4 cells, until the patient’s immune system is so badly compromised that it will quickly succumb to serious infections and illnesses.

Not everyone with HIV will go on to develop AIDS but without treatment, AIDS is the final stage of HIV.

Acquired immunodeficiency syndrome (AIDS)

A person with HIV is considered to have developed AIDS when the count of their CD4 cells falls below 200 per cubic millilitre of blood. In a healthy adult, this count is normally between 500 and 1,500. AIDS could also be diagnosed, regardless of the CD4 count, if someone develops opportunistic infections or a cancer which is rare in those without HIV.

  • Without treatment, HIV can develop into AIDS within a decade.
  • With treatment, the progression to AIDS can be halted indefinitely. This means that people receiving antiretroviral medication for HIV can have a normal or near-normal life expectancy, as long as treatment starts early enough.
  • By the same token, although there is technically no cure for AIDS, it is possible that treatment can cause the CD4 cell count to return to above 200. Someone in this situation would no longer be considered to have AIDS.

What are the symptoms of HIV and how can you recognise them?

How long does it take for symptoms of HIV to show?

HIV is so readily transmittable, and therefore dangerous, because some people may only have very mild symptoms during its acute infection stage – the first few weeks after the virus is contracted. Most people in fact may not even have symptoms at all.

What are the early symptoms of HIV?

When there are symptoms in the early stages, these can easily be confused with flu or other seasonal viruses. The person experiencing early symptoms of HIV may not think they need to see a doctor. Symptoms can include chills and fevers, a headache, a sore throat, swollen lymph glands, a skin rash or an upset stomach.

Later HIV symptoms

After the acute stage, HIV enters the clinical latency stage which can last for years, or even decades. Some people will still show no symptoms. Others may have non-specific symptoms, such as:

  • Recurrent fevers and night sweats;
  • Vomiting or diarrhoea;
  • Weight loss;
  • Other viral infections, such as shingles or yeast infections.

Symptoms of AIDS

With antiretroviral therapy, a person with HIV can be stable with the chronic condition for many years. However, without appropriate and consistent treatment, and with a severely compromised immune system, AIDS can develop. Symptoms of AIDS can include:

  • Recurrent or chronic diarrhoea and rapid weight loss;
  • Bumps, lesions, rashes, or dark patches on or under the skin;
  • Neurological problems including depression, difficulty with concentration or confusion;
  • Opportunistic infections or specific cancers that are rare in those without HIV or immunosuppression.

While antiretroviral therapy helps to prevent HIV from developing into AIDS, it also helps to reduce the risk of transmitting the infection on to others. This is because antiretroviral therapy brings down the viral load: the number of viral particles in the organism.

When should I see a doctor?

The NHS advises that you should see a doctor immediately if you think you may have been exposed to HIV. They also stress that the only way to know if you have HIV is by getting a test. Early diagnosis means you can start treatment sooner, which minimises the risk of the disease causing serious illnesses. It can also reduce the risk of passing the virus to others. You can get tested in GP surgeries, sexual health clinics or many charitable organisations. You can find a test centre in several ways:

Can HIV affect my fertility?

Couples where one, or both, partner(s) is/are infected by HIV might need to seek fertility advice to:

  • Minimise the risk of transmission of HIV to a partner;
  • Treat fertility problems while trying to conceive.

It is not impossible to have a baby if you or your partner are HIV positive. Many HIV positive couples have children with near zero risk of passing the infection to their offspring. However, women who are HIV positive might experience subfertility and, in some cases, poorer outcomes with assisted reproductive technology (ART). Evidence suggests this is because the HIV infection can interfere with the reproductive system, both directly and indirectly. For these reasons, HIV positive couples might need extra help when trying to have a baby.

Where a male partner is a carrier of HIV, their semen sample must be washed before being used in any fertility treatment in order to get rid of potential virus particles.

Where a female partner is a carrier of HIV, there is a risk of vertical transmission. This is where the HIV infection is transmitted by the mother to her baby during pregnancy, delivery, or when breastfeeding. Although the risk of vertical transmission is relatively low (<2%), preventative measures must be taken to minimise this risk as much as possible.

Similarly, it is important to consider that women who are HIV positive show an increased risk of preterm birth, preeclampsia (high blood pressure during pregnancy), intrauterine growth restriction and stillbirth.

While taking all of the above into consideration, it is best to take a multidisciplinary approach when undergoing fertility treatment as a HIV positive couple or individual. This means monitoring and controlling your infection, while also taking steps to minimise the risk of transmission for you, your partner and your baby.

If you or your partner are HIV positive and seek fertility treatment, IVI can help. Whether you’re ready to start treatment, need guidance on which options you have, or if you’re just looking for more information, get in touch with our team here.

How to support World AIDS Day

Show your support by wearing the red ribbon on 1 December to challenge stigma and show respect for people living with HIV. You can also get involved in a fundraiser too. Take a look for more ideas and information from World AIDS Day on their website.

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