With advances in research in drug treatment, the discovery of the highly active antiretroviral therapy(HAART) was birthed. These drugs when consistently taken can ensure the almost normal quality of life in those infected with the virus.
But successes to therapy depends on two major patient-factors; early diagnosis through post-exposure screening and compliance to medications when confirmed positive. The best indications of the level of infection are with the viral load and the CD4 count. Low CD4 counts and high viral loads refer to high disease levels.
Confirming anyone as positive for HIV is not a death sentence, and in this case of discordant couples, it is not a reason to separate either. However, there lies a major challenge embroidered in the desire to prevent infection of the other partner and other members of the family.
This may present with numerous problems that may prove really disastrous if not properly handled.
Now the most pressing question is, what are the options available for a discordant couple and their family?
I hope to answer the following questions:
- Can they still remain together?
- What are the options?
- Can they have a child naturally?
- Will the child be HIV positive?
- How do you treat HIV in discordant couples?
- Can they have sex normally?
These can include mother-to-child transmission, via infected instruments, blood transfusion, etc.
Can a Discordant Couple Still Remain Together?Of course, yes. Irrespective of the route through which the disease was acquired, a consenting non-infected couple would agree not to let his/her infected partner leave his life. They can continue to live their normal lives and not infect other members of the family including the other non-infected partner and the children.
With the right precautionary measures, a discordant couple can engage in unprotected sexual intercourse without the risk of transmission to the non-infected partner.
What Are The Precautions To Avoid TransmissionThe standard treatment for HIV currently suffices to prevent transmission to uninfected persons in the family. This involves the highly active antiretroviral therapy(HAART), which includes the use of some antiviral agents called the reverse transcriptase inhibitors.
National and international health bodies have made treatment for HIV free of cost after diagnosis. There are centres where these drugs are dispensed at no cost in many different locations. These drugs guarantee a near-normal quality of life with almost normal life expectancy if the patient is compliant with hospital visits and medications.
By testing for the HIV viral load, the level of infectivity can be accessed. When the viral load is markedly low, the risk of transmission to the uninfected partner even during unprotected sex is drastically reduced.
The HAART medications can reduce the viral load to undetectable levels at which point the infected individual cannot infect any new person including his/her marital partner following active unprotected sexual intercourse. The antiviral drug Zidovudine has been approved as prophylaxis for pregnant women and newborn to prevent perinatal transmission.
Can The Couple Naturally Have a Child?The impact of HIV infection on a discordant couple depends on which partner is the infected partner. If the husband is the infected partner, the impact is greatly reduced in a typical family setting. However, the tension may be more when it is the wife that tested positive to the virus.
The couple can have children via conception without infecting the unborn child, but there are some precautions that must be observed during conception and delivery:
When done appropriately, the child can remain negative to the virus and would live as if none of his/her parents ever tested positive to the virus. Precautions to prevent transmission via other routes within the home will continue to be observed. However, because of the less-tolerance nature of the virus, transmission via those other routes is often very low. The enveloped RNA virus cannot survive long on solid non-living objects beyond a few minutes.
- Compliance with antiretroviral therapy during conception
- Constant monitoring of viral load
- Opting for an elective compulsory caesarian section for delivery
- Quickly clamping the umbilical cord after delivery of the child
- Minimizing contact with blood and body fluids of the mother outside the uterus(womb)
- Post-exposure prophylaxis for HIV given to newborn
- Breast milk substitutes may be advised
Treatment for Discordant CoupleTreatment guidelines for a discordant couple are the same as in other infected people. Anti-retroviral therapy must be prescribed to the seropositive partner irrespective of the viral load or CD4 count.
In couples who want to conceive, CDC outlines the following options in its Morbidity and Mortality Weekly Report (MMWR);
- When the woman is HIV-positive, the couple can use autologous sperm intrauterine insemination (IUI) to conceive without putting the man at risk.
- When the man is HIV-positive, the couple may choose to:
- Use sperm from an HIV-negative donor; this is the safest option.
- Use highly active antiretroviral therapy (HAART) to suppress HIV in the man and have condomless intercourse only near ovulation while the woman is using daily preexposure prophylaxis (PrEP).
- Have the man's sperm collected and "washed" to remove HIV-infected cells. After washing (described in MMWR below), the sperm cells are tested to confirm the absence of HIV and then used during IUI or in vitro fertilization. This procedure — which should be used in conjunction with HAART and PrEP — has been performed roughly 11,500 times, with no HIV transmissions to the woman or offspring.
With the observance of all these precautions, it is possible to have serodiscordant or discordant partners still work things out in the home without any chance of separating or breaking up.
Diagnosis of HIV is not a death sentence. Early diagnosis and prompt response to antiretroviral medication is key to the best overall outcome and better quality of life.
WHO drugs HIV management during conception