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New Canadian guidelines for HIV pregnancy planning

By Anne Coffey

People with HIV are now experiencing an improved quality of life and are living longer, thanks to combination antiretroviral therapy which suppresses the HIV virus and stops the progression of HIV disease. This therapy also prevents the transmission of HIV to others.

Another key trend in HIV epidemiology is the rising rate of HIV infection in women. As of 2016, it was estimated that 16,880 Canadian women were living with HIV, accounting for about 22.4 per cent of the national total. 

Given these changes, and the fact that 70 per cent of Canadian men and women with HIV are of reproductive age, the arrival of the updated Canadian HIV Pregnancy Planning Guidelines (CHPPG) is timely. Dr. Mona Loutfy, scientist and physician at Women’s College Hospital, led the development of the original, and revised, CHPPG which was published in the Journal of Obstetrics and Gynecology in January 2018.

“With the success of current treatments, the risk of HIV transmission to a baby when the pregnant woman is on effective combination antiretroviral therapy before pregnancy is zero,” says Dr. Loutfy. “That is amazing. And so, many people with HIV and couples affected by HIV are considering having children.”

The new guidelines put forth 36 recommendations to provide clinical information and recommendations for health care providers' counselling and care in order to assist people and couples with HIV in Canada. The four main clinical issues are identified: 1) healthy preconception; 2) reduction of perinatal transmission to the infant; 3) reduction of horizontal transmission between partners during conception; and 4) management of fertility issues and in the fertility clinic.

“These guidelines were developed with the World Health Organization’s human rights’ premise that all couples and individuals have the right to decide freely and responsibly the number and spacing of their children and to have access to the information, education and means to do so, including people with HIV,” Dr. Loutfy explains.

Despite the fact that many people and couples with and affected by HIV wish to have children, a limited number of fertility clinics in Canada offer assisted reproductive services for people with HIV. It is the intention of the CHPPG Development Team to close this gap and closely monitor the uptake of these guidelines.

Read the full guidelines and learn more about the Women and HIV Research Program.

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