HIV Infection and Infertility

Human immunodeficiency virus (HIV) infection has become a chronic and manage‐ able disease since the availability of combination antiretroviral therapy (cART). Per‐ sons living with HIV are living longer with better quality of life. Given that worldwide many HIV-infected individuals are in the reproductive age, fertility and reproductive desire have emerged as clinically important issues among this popula‐ tion. Biological changes caused by HIV, including systemic illnesses, stress, and weight loss, may affect the function of reproductive organs and result in infertility. Newly diagnosed HIV infection may cause psychological trauma and decrease in sexual drive and sexual activity. Several HIV/acquired immune deficiency syn‐ drome (AIDS)-related comorbidities have been reported to be associated with infer‐ tility. These include orchitis, acute epididymitis, and pelvic inflammatory disease caused by opportunistic pathogens and coinfections with sexually transmitted in‐ fections (STIs) acquired through a similar route of transmission as HIV. The com‐ mon STIs caused by Neisseria gonorrhoeae, Chlamydia trachomatis, Ureaplasma urealyticum, Treponema pallidum, herpes simplex virus-2, and Trichomonas vaginalis can damage the reproductive system and cause infertility. Hypogonadism especial‐ ly in men with AIDS is one of the important endocrine disorders that causes infertil‐ ity. Although cART provides significant benefits in reducing morbidity and mortality among HIV-infected persons, some antiretroviral drugs, including nu‐ cleoside reverse transcriptase inhibitors, are toxic to cellular mitochondria and may affect the mitochondrial biogenesis of sperm and oocytes. HIV-infected individuals may have limited access to reproductive care given the severity of their disease, cost of care, stigmatization, and lack of specific HIV infection/infertility knowledge among their providers. In the post–cART era, reproductive care has become an important issue to be co‐ managed with HIV care. Reproductive care includes not only comprehensively managing HIV infection but also minimizing the risk of horizontal HIV transmis‐ sion in serodiscordant couples, providing suitable options for unprotected timed in‐ tercourse, intrauterine insemination with partner or donor sperm, in vitro fertilization with intracytoplasmic sperm injection (IVF/ICSI), embryo donation, and adoption. This chapter reviews potential effects of HIV infection, related oppor‐ tunistic infections, and physical and psychological comorbidities on fertility; the im‐ © 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. pact of cART on fertility; and the management of reproductive issues among HIVinfected individuals.