CDC Recommends Conception Strategies When an Uninfected Woman’s Male Partner is HIV Positive
Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Discuss the medication that male and female partners should use when an uninfected woman’s male partner is HIV positive 2. Recall the 2 strategies for couples who want to conceive when a woman is HIV negative and her partner is HIV positive
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Dec 31 2021, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
The CDC has identified strategies for couples who want to conceive when a woman is HIV negative but her partner is HIV positive. Thanks to highly active antiretroviral therapy (HAART), men and women are living longer, with better quality of life and may wish to have their own biologic children. The safest option remains sperm insemination from an HIV-negative donor. However, if donor sperm is not an acceptable option, the CDC presents the following risk reducing approaches for consideration:
Both partners should be on medication, regardless of strategy:
daily while attempting conception, ideally beginning approximately 20 days before exposure
Strategy 1: Intercourse without condom limited to ovulation
Men on HAART with undetectable plasma viral loads might still be at low risk (1.2 per 100 person-years, CI = 0.9–1.7) for transmitting HIV-1 to their female partner through condomless sexual intercourse
Strategy 2: Collection and washing of the male partner’s sperm to remove cells infected with HIV with follow up testing to ensure absence of HIV prior to IUI or IVF
1.3%–7.7% of washed specimens may test positive after washing and should be discarded
Unknown whether there is greater benefit with IVF vs. IUI
In theory, because IVF is more efficacious compared to IUI, there may be reduced exposure to infected sperm
Unknown if any difference with ICSI
The authors of the CDC Morbidity and Mortality Weekly Report (MMWR) refer to ACOG and ASRM guidance:
The American College of Obstetricians and Gynecologists, the American Society of Reproductive Medicine, and others have published guidance documents that emphasize the importance of considering HIV a chronic disease or disability, which should not result in discrimination and for which fertility treatment should be offered if it is desired.
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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