Sperm washing—and effective but costly fertility treatment for HIV-serodiscordant couples—may no longer be necessary, at least in the United Kingdom, under certain circumstances, according to draft guidelines from the National Institute for Health and Clinical Excellence (NICE) summarized by aidsmap.

According to NICE, provided that the male partner living with HIV is strictly adherent to antiretroviral therapy, has an undetectable viral load, doesn't have other sexually transmitted infections and limits unprotected sexual intercourse to days when his female partner is ovulating, the additional step of sperm washing may do little to further reduce the risk of transmitting the virus.

Should the male partner have problems adhering to antiretroviral therapy or his viral load is detectable, the draft guidelines recommend testing viral load levels in seminal samples. “If HIV is undetectable in semen,” aidsmap reports, “doctors should inform the couple that the risk of HIV transmission during timed unprotected intercourse is ‘negligible.'”

In situations other than these, sperm washing should still be recommended.

Interestingly, the draft writers do not recommend pre-exposure prophylaxis (PrEP) for the HIV-negative female partner. “They found only two studies in peer-reviewed journals that shed light on the question and that this evidence did not support the use of PrEP,” aidsmap reports.

Whether or not similar guidelines will be proposed in the United States isn't clear.