HIV Positive Intended Parent Information
Dear Intended Parent,
Thank you for your interest in our program which assists people with HIV to create their families through surrogacy. The goal of this program is take every step possible to ensure the health and safety of the surrogate and the intended parent’s child by utilizing the very latest advances in assisted reproduction techniques, laboratory testing and preventative medications.
Before I outline the medical aspects of our program, I wanted to provide a brief introduction. My name is Dr. Dan Bowers and I have been a physician with a specialty in HIV for over 20 years. I am also a father through assisted reproduction so the issues of our program are both professionally and personally very dear to me.
The purpose of the information below is three-fold:
- To provide the latest safety data on the risk of HIV transmission from an HIV-positive male to an HIV-negative women using assisted fertilization techniques
- To list the processes involved to provide this safety
- To highlight the steps that the Intended Parent and Dr. Brad Kolb of HRC will take to not only meet, but exceed, current safety standards. Additionally, relevant data on the risk of HIV transmission through unprotected intercourse when a partner has an undetectable viral load is reviewed.
What is the history of using sperm from an HIV-positive man in assisted reproduction?
The technique of washing the semen from an HIV positive man for the purpose of artificially inseminating an HIV-negative woman began in 1992, at a time when we did not have fully suppressive HIV regimens or the ability to measure HIV in the blood. Since then, there have been many advances in sperm washing and assisted reproduction techniques beyond basic intrauterine insemination to in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). In 1996 the ability to measure the amount of HIV in the blood – the viral load – was developed. At the same time the first three-drug regimens became available which could suppresses HIV to undetectable levels. This then allowed for the selection of sperm donors with the lowest risk of having HIV in their semen.
Has there ever been a transmission of HIV in assisted reproduction?
To date in the reported medical literature, there has not been one case of HIV transmission involving 3700 cases of intrauterine insemination and 800 cases of either IVF or ICSI, including data from those early days of inadequate HIV therapy and monitoring.
Independent of assisted reproduction, studies have looked at the risk of HIV transmission through intercourse between serodiscordant couples (one HIV positive and one HIV negative) when the positive partner has an undetectable the viral load. The conclusion is that the risk is extremely small – so small that the Swiss Federal Commission for HIV/AIDS issued the following formal statement in 2008. It said that an HIV-infected person on antiretroviral therapy with an undetectable viral load is not sexually infectious, i.e. cannot transmit HIV through sexual contact.
What steps are taken to ensure safety for the surrogate?
The Swiss Federal Commission for HIV/AIDS explained that this non-infectiousness continues as long as the following three criteria are met:
- The HIV-positive partner remains fully adherent to the HIV medications and is regularly monitored
- The viral load has been fully suppressed for at least six months
- There have been no other sexually transmitted infections (STI)
To meet these criteria the following steps will be required:
- The Intended Parent(s) must provide records from his HIV physician to document at least six months of an undetectable viral load (<48) on a stable regimen which has not been changed during that time period. This must include one viral load within two weeks of sperm donation. These records will be reviewed by me.
- The Intended Parent must undergo complete infectious disease screening and it will be repeated if more than seven days have elapsed before semen donation.
- The Intended Parent must provide 2 to 3 semen samples that are washed in a two-step process, a small portion of which will be sent to an HIV specialty lab to test for any residual virus. Although most men with undetectable viral loads in their blood also have undetectable HIV viral loads in their semen, sometimes a very low amount of HIV is found.If any HIV is detected, the specimen will be discarded, even though studies have shown that this low level of HIV is not infectious.
- As an additional precaution, the surrogate will be prescribed a medication to further reduce the chances of any viral transmission. This is called pre-exposure prophylaxis.Very recent studies show that giving the antiretroviral medication Truvada (tenofovir plus emtricitabine) to an HIV-uninfected partner prior to exposure reduces the risk of transmission through unprotected intercourse with an HIV-positive partner by about 70-90%. An FDA advisory panel has recommended the approval of Truvada for HIV serodiscordant couples, which is what, in essence, a surrogate and an intended parent are. This medication is safe to give during the first trimester of pregnancy and will start just prior to your embryo transfer through one month after your embryo transfer.Truvada is one of the more frequently prescribed HIV medications during the last ten years and is extremely well tolerated.
I look forward to personally speaking with you as we review your records and coordinate your case. Please be in touch with your Growing Generations Client Services Coordinator to schedule our appointment and coordinate the release of certain medical records from your primary HIV physician to my office.
Dr. Dan Bowers
About Dr. Dan Bowers
Dr. Dan Bowers, the Medical Director for the HIV-Associated Assisted Reproduction Program, will be meeting with you to review this information and answer any questions.
Daniel H. Bowers, M.D. is a board-certified Family Physician and a nationally recognized HIV physician. Born in a small town in Iowa, Dr. Bowers got his undergraduate degree from Stanford University and his medical degree from the University of Iowa College of Medicine. After completing his family practice residency at the University of Minnesota Medical School in 1980, Dr. Bowers joined a small family practice clinic in the Como Park area of Saint Paul where he delivered babies, set fractures, performed minor surgery, ran a nursing home, and cared for families that were five generations deep. He also continued to teach in the Family Practice Department of the University of Minnesota Medical School. As an openly gay physician, Dr. Bowers was one of the first doctors to see gay men with swollen glands and recurrent infections at the beginning of the HIV/AIDS epidemic. As one of the pioneers in this field, Dr. Bowers was an early spokesperson against AIDS discrimination and a vocal advocate for public education and awareness programs.
In 1989 Dr. Bowers moved to Los Angeles to join Pacific Oaks Medical Group, the largest private practice in the country specializing in HIV, whose founders reported the original five cases of AIDS to the CDC in 1981. For the next nineteen years Dr. Bowers participated in the evolution of the treatment of HIV/AIDS from the care of those struggling with AIDS through the arrival of triple drug combination therapy to the present state-of-the-art treatment of HIV as a long-term manageable disease. As a senior partner at Pacific Oaks, Dr. Bowers became a thought leader in the field of HIV/AIDS and has lectured, consulted, and written extensively on the subject. At the same time he also maintained a large and diversified practice in general adult medicine, with special interests in travel medicine, male aging, and sexually transmitted diseases.
In 2008 Dr. Bowers moved to New York City and is now practicing in Manhattan.
On a personal basis, Dr. Bowers has served on numerous not-for-profit boards, both local and national, and has been a frequent community lecturer for a variety of AIDS service organizations. He is a professionally trained choral singer. He and his spouse have one son.