[Reproduction and HIV: has the condom become irrelevant?]

With antiretroviral therapy, the risk of HIV transmission from an infected person to a stable heterosexual partner is very low when a sustained undetectable viral load is achieved, in the absence of associated genital tract infections. However, epidemiological data do not prove that there is no risk at all. Virological data confirm that when the blood viral load is undetectable for several months, the viral load in semen usually becomes undetectable, but viral shedding can persist in some cases. Two different issues are involved: 1): Can we do without assisted reproductive in HIV sero-different couples who want to have a child? and; 2): can couples in which one or both members are HIV positive entirely stop using condoms? The current French guidelines consider natural conception to be a reasonable option for these couples, recommending self-insemination when the woman is HIV positive and timed unprotected intercourse when the man is HIV positive. Preconceptional care should be available, including viral load monitoring, detection of genital infections and an estimation of the couple's potential fertility. On the other hand, we must strongly discourage unprotected sex in high-risk situations. The best prevention of risk behavior is to offer complete information and appropriate support to people with HIV who wish to conceive.