Question
Can an HIV negative woman and her HIV positive partner conceive naturally?
16 January 2018. Related: All topics, PEP/PEPSE, Pregnancy, Sero different couples.
My boyfriend is HIV positive and I am negative. We have unprotected sex regularly and are interested in becoming pregnant the old fashioned way rather than using the sperm washing method.
– What are my chances, percentage wise, of catching HIV?
– How often should I get tested?
– How long does it take for the infection to be detectable?
– Will my baby be at risk?
– Will the baby automatically be HIV positive?
– Is this a very ignorant choice?
– Should I take the medications as well as a precaution?
– Also, is my three year old daughter who lives with us at risk? What should I do to keep her safe?
– What are safe viral load counts for him to have?
I feel very confused, but I love my boyfriend and enjoy our sex life. Please answer these questions and ease my anxiety a bit.
Answer
Thank you for your questions. I shall try and answer them one at a time.
Modern HIV meds are so effective that they also protect your partner. Spermwashing has not been needed or recommended for many years.
What are my chances, percentage wise, of contracting HIV?
An HIV negative woman and an HIV positive man can conceive naturally.
This can be done through limited conception attempts during the most fertile days of your cycle. i.e when you are as ovulating.
If your partner has an undetectable viral load on treatment (ideally for a few months), then the risk becomes zero.
The PARTNER study reported zero HIV transmissions after about 900 couples had sex than 58,000 times without a condom when the positive partner had an undetectable viral load.
For more information on HIV and natural conception, please follow this link on HIV and pregnancy and this link on the Swiss Statement.
How often should I get tested and how long does it take for the infection to be detectable?
For information on HIV testing and the window period [time between exposure and when infection can be picked by an HIV test], please follow this link
Will the baby automatically be HIV positive?
As you are HIV negative, the baby will be HIV negative.
Will my baby be at risk?
Your baby can be at risk if you become HIV positive whilst pregnant and your viral load is very high. Returning to using condoms after you become pregnant might still be a good idea, even when your partners viral load is undetectable.
A high viral load is one of the main risk factors for transmission. If viral load is detectable, there is a higher risk of catching HIV during pregnancy.
Transmission to the baby can occur at 3 stages, but only if you become HIV positive.
- During pregnancy
- At the time of delivery
- Through breast-feeding.
However, there are interventions to reduce the risk of transmission to the baby during pregnancy and birth. These include:
- Taking treatment so that viral load is undetectable by the time of delivery
- Giving the baby a course of treatment for the first 4 weeks of life.
For more information please follow this link.
Is it an ignorant choice?
This is not an ignorant choice. Many thousands of couples in your situation have children naturally. Luckily treatment now dramatically reduces the risk of transmitting HIV if this process is done carefully.
However, it is important that both you and your partner make an informed choice. It is recommended that you discuss your options with your doctor.
Should I take medication as a precaution?
Sometimes PrEP [Pre exposure Prophylaxis] and PEP [Post Exposure Prophylaxis] are used an additional precaution. This involves taking a single dose of treatment before and after having sex.
PrEP is not likely to add much or any protection, because having an undetectable viral load is enough. It might help for psychologically if you are nervous. PrEP is very effective too.
More information on PrEP is at this this link
Is my 3 year old at risk and what should I do to keep her safe?
Your 3 year old is not at risk as HIV is not transmitted from daily activity.
What are safe levels for my partner’s viral load?
The risk of transmission is so low when your partner has an undetectable viral load that is it generally thought to be close to zero.
Note: This question was updated in January 2018 and September 2016 from an original answer in September 2011.
Hello Laurry,
PEP should not be taken in this way. Some HIV drugs should never be used as PEP. If you were going to use PEP it should be prescribed by a doctor and started within 48 hours of exposure. There is more information about PEP in our transmission guide.
Because she is on treatment the girl you slept with is very unlikely to have infected you. If her viral load is undetectable the risk is very small. Please take a look at this link for information about viral load and risk of sexual transmission
I had sex with a girl who later told me that she is hiv positive and has been on ART for about 1year now. She tells me that i cannot be infected, but if i insist i can take her ART as a PEP for a month and then go for testing thereafter to be sure.
Now i do not know if it is true that the chances are low enough for me not to bother taking the ART and what time frame should ART be administered from date of this incident. I appreciate your response.
Hi Thandiwe,
By starting treatment at four months into your pregnancy you have reduced the chance of passing HIV to your baby. There is still a chance that this could happen but this is less likely. Please follow this link to our guide to HIV, pregnancy and women’s health. The guide contains a lot of information about how to reduce the chance of your baby being infected.
Can you tell me more about the treatment you have been given? HIV treatment helps to improve the CD4 count so your CD4 should increase if you are on a combination therapy with 3 HIV drugs. If you are only taking one drug to reduce the possibility of transmission to your baby you can help maintain your CD4 by eating healthily and exercising regularly.
am six months pregnant and only discovered that i was hiv positive at four months but was put on medication immediately, could the baby be infected? And how can i maintain my CD4 count, its at 625?
Dear Tiny
It is possible for you and your partner to try for a baby naturally. Re-infection is only a risk if one of you has extensive drug resistance and a detectable viral load, or if neither of you are taking ARVs. For more information on natural conception for positive couples, please follow this link to our guide to HIV, pregnancy and women’s health.
http://i-base.info/guides/pregnancy/both-hiv-positive
Your second question was whether the baby will be infected or not. The main way to prevent transmission of HIV to the baby is by ensuring that the mother has an undetectable viral load by the time she delivers. ARVs (antiretroviral treatment for HIV), are the only proven way of achieving and maintaining an undetectable viral load.
You mention that you are not yet taking ARVs. If you did get pregnant, you will need to start taking ARVs in order to prevent transmission to your baby. Both BHIVA (British HIV Association) and WHO (World Health Organisation) guidelines for the management of HIV in pregnancy, recommend treatment for all pregnant positive women.
As treatment is individualised, whether you continue taking treatment after you deliver will depend on a number of things. These include what your CD4 count was when you started, how you feel about continuing treatment, and sometimes on the guidelines for the country where you live.
Good luck with your future plans.
Hi, me and my partner would like to have a baby. We are both HIV+. He is on treatment with undetectable viral load and CD4 of just over 550. My CD4 count is 1186 an viral load of 513 and not on treatment. What are the chances of trying for a baby naturally without re- infecting each other? What are the safety measures to take in to consideration. Will the baby be infected or not?
Hi Sandra
If your partner has undetectable HIV viral load, then there is such a low risk of you catching HIV, that most couple prefer to conceive naturally instead of using sperm-washing.
Although sperm-washing was a great innovation things have advance in our understanding of how well treatment can prevent infection. This would only be for the few days in the month when you are most fertile, until you become pregnant, and then you could return to using condoms.
See the “Planning your pregnancy” sections from the i-Base guide to pregnancy:
Planning your pregnancy
• Preconception, planned pregnancy, and your rights to have a baby
• When the man is HIV positive and the woman HIV negative
• The Swiss Statement
• Can I get help if I am having difficulty conceiving?
It would also help if you and your partners doctor were supportive. Sometimes there is still prejudice and if you are experiencing this get a more supportive doctor – which might be your partners HIV doctor.
Hepatitis C is generally not sexually transmitted by heterosexual sex, but you could also reduce all risk if you decide to self inseminate (turkey baster etc).
Dear Riri
I am sorry about your diagnosis at that stage of your pregnancy. I can appreciate that it must have been quite a difficult time for you to find out about your HIV status. How old is your baby now and how is he doing health wise?
In response to your question, the only way you can find out about your son’s status for certain, will be for you to have him tested for HIV. I can appreciate that this will not be easy for you to do. However, it is the only way you will be able to know for sure and have peace of mind, as well as know what steps to take next.
Good luck.
I have a prematured baby at 7 months. I only tested while I was 5 months and I was negative. At 7th months I tested again only to find out that I am positive. The next day i gave birth to a baby boy. Do you think my baby might be also positive?
Hi, Me and my partner want so much to have a baby for a long time. I am negative and he is positive, but he’s virol iload is very low, he is undetectable but he has hepatite C. He is 39 and I am 33 and we know we are fertile. And we do tests frequently and safe sex. Our problem is that we dont have so much money to do sperm washing and we are getting depressed because we are afraid that if we do unprotect sex to have a baby I can get infected and also the baby. How can we get this Pep or Prep procedure whithout spending so much money? We just want to have a healty baby now that we find the right person but at the same time we feel under pressure because the clock is beating. Please can you give us some advice?