Table 2.

Recommendations for mutually disclosed serodiscordant couples who choose to attempt conception through intercourse and have completed baseline fertility and preconception evaluation(s)

Risk reduction approaches	Laboratory follow-up
M+F− serodiscordant couples	Infected partner	Uninfected partner
Infected partner on ART with suppressed viral load Sperm washing +assisted reproduction	Standard VL, CD4, safety lab monitoring while on ART	Monthly HIV Ab test (VL based on symptoms and availability) Monthly pregnancy test
Infected partner on ART with suppressed viral load (or on effective regimen for ≥6 months) Daily oral PrEP with FTC/TDF for the uninfected partner until pregnancy achieved Sex without condoms limited to peak fertility		Monthly HIV Ab test (VL based on symptoms and availability) Monthly pregnancy test Baseline and monthly renal function while on PrEP Ovulation monitoring (home LH kits, basal body temperature, cervical mucus monitoring)
F+M− serodiscordant couples	Infected partner	Uninfected partner
Vaginal insemination with collected semen (home or clinic) at peak fertility	Routine VL, CD4, safety lab monitoring for infected individual on ART Monthly pregnancy test Ovulation monitoring (home LH kits, basal body temperature, cervical mucus monitoring)	Monthly HIV Ab test (VL based on symptoms and availability)
Infected partner on ART with suppressed viral load (or on effective regimen for ≥6 months) MMC Daily oral PrEP with FTC/TDF for the uninfected partner until pregnancy achieved Sex without condoms limited to peak fertility.		Monthly HIV Ab test (VL based on symptoms and availability) Baseline and monthly renal function while on PrEP

Ab, antibody; ART, antiretroviral treatment; F+M−, female-infected couple; FTC/TDF, emtricitabine/tenofovir disoproxil fumarate; LH, luteinizing hormone; M+F−, male-infected couple; MMC, male medical circumcision; PrEP, pre-exposure prophylaxis; VL, HIV viral load.