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ART Likely Less Effective In Women With HIV Versus Other Chronic Viral Illnesses

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  1. The Good Doctor

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    HIV-infected women who underwent assisted reproductive technology (ART) had a lower live birth rate than those with chronic hepatitis-B (HBV) or hepatitis-C (HCV) virus in a cohort study.

    Dr. Pietro Santulli of Centre Hospitalier Universitaire Cochin in Paris studied women with a chronic viral illness who were infertile for at least a year and who underwent in vitro fertilization (IVF) or intracytplasmic sperm injection (ICSI) from 2012-2018.

    Women were followed until four IVF/ICSI cycles had been completed, or delivery, or treatment discontinuation before completion of four cycles.

    As reported in AIDS, 235 women with HIV (101), HBV (114) or HCV (20) were included in the analysis. The mean age was about 35; causes of infertility included male factor (28.9%), tubal factor (22.9%), diminished ovarian reserve (17%), and multiple etiologies (13.6%).

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    Of note, compared to the HBV-infected group, the HIV-infected group had significantly more tubal causes of infertility (30.7% vs. 14.9%) and lower ovarian reserve parameters (anti-Mullerian hormone, 2.59 vs. 3.29; antral follicle count, 12.61 vs. 15.25).

    The cumulative live birth rate was significantly lower (39.1%) in HIV-infected women compared to those with HBV (52.8%). Further, the mean birth weight was lower those with HIV compared with HBV or HCV.

    Multivariate analysis showed that age, AMH, and the number of cycles performed were significantly associated with the chances of a live birth.

    The authors conclude, "HIV-infected women had lower cumulative live birth rate than women with chronic hepatitis, and this was due to less favorable ovarian reserve parameters. These findings underscore the need to better inform practitioners and patients regarding fertility issues and the importance of early fertility assessment."

    Dr. Santulli did not respond to requests for a comment, but three experts provided their perspectives in emails to Reuters Health.

    Dr. Tina Yarrington, Director of Labor and Delivery and Medical Director of the Positive HOPE team at Boston Medical Center, said, "There is limited information about the success of IVF in women living with HIV or viral hepatitis and this study contributes to our knowledge. However, as the article did not provide specifics on antiviral/antiretroviral regimens of the subjects, the results cannot easily extrapolate to clinical strategies for women entering ART."

    "A pregnancy is only as healthy as the mother, and women deserve to be treated for their own health first - whether for HIV or viral hepatitis," she said. "Optimal care depends on targeted, simplified therapy."

    Dr. Joseph Alvarnas, Clinical Professor in the Department of Hematology and Hematopoietic Cell Transplantation at City of Hope in Duarte, California, commented, "The findings are somewhat limited due to the relatively small sample size, the confounding variable of a higher prevalence of fallopian tube-related clinical issues in the HIV-infected women and the retrospective nature of the analysis."

    "Moreover," he noted, "the women received care at a tertiary care center, which may impact the potential generalizability of the study findings."

    "Despite these limitations," he said, "this report does help to provide an important set of foundational data in better understanding the potential effectiveness of ART for women with HIV, HBV or HCV infection who require fertility-related health interventions. While the authors do make some observations regarding ovarian reserve in women with HIV infections, these observations are far from conclusions and require additional study."

    Dr. Cathy Creticos, Director of Infectious Diseases at Howard Brown Health in Chicago, commented that for women with HIV, no information was given on the duration of infection or the specific medication regimen and for women with HBV, there was no information about viral load or treatment - all data that might have impacted results.

    Further, she noted, "The study suggests there is a signal that women living with HIV may have lower ovarian reserves, and although the pathophysiology for this is unclear, this may impact chances of a live birth with ART. Age was found to be a factor, and discussing ART options earlier in the process of fertility management with women living with HIV may be appropriate.

    "Additional studies are needed to further elucidate the particular concerns for women living with chronic HIV or viral hepatitis," she concluded.

    —Marilynn Larkin

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