INTERSECTING PATHWAYS: THE COMPLEX RELATIONSHIP BETWEEN HIV AND FERTILITY IN WOMEN WITH SICKLE CELL DISEASE

Women with both human immunodeficiency virus and sickle cell disease face distinct reproductive hurdles stemming from intertwined biological, pharmacologic, and psychosocial influences. Each condition separately affects fertility due to immune dysregulation, persistent inflammation, hormonal interference, and blood vessel issues, while their simultaneous presence intensifies these impacts. This narrative review examines the intricate connections between HIV and SCD in women, highlighting processes that influence ovarian function, fertility preservation, safe conception, and maternal-fetal results. Literature related to the topic was compiled from PubMed, Scopus, Web of Science, and Google Scholar, concentrating on research about fertility, reproductive endocrinology, management of hematologic and infectious diseases, and the effects of antiretroviral therapy and hydroxyurea. Global standards from the World Health Organization and the Centers for Disease Control and Prevention were included to frame clinical recommendations. HIV and SCD intersect via mechanisms such as oxidative stress, endothelial dysfunction, gonadal suppression, and chronic inflammation, resulting in reduced ovarian reserve, menstrual irregularities, and subfertility. Pharmacologic treatments, although crucial, may have cumulative gonadotoxic impacts, underscoring the necessity for fertility preservation methods. Multidisciplinary approaches that incorporate hematologic stabilization, optimization of ART, reproductive counseling, and strict adherence to PMTCT guidelines enhance reproductive results and lower the risk of vertical transmission. The convergence of HIV and SCD creates complex reproductive issues that necessitate personalized, evidence-based care. Timely preconception counseling, comprehensive clinical care, and focus on psychosocial elements are essential for maintaining fertility and safeguarding maternal and fetal health. Additional studies are necessary to clarify the lasting impacts of ART and hydroxyurea on ovarian reserve and pregnancy results. Peer Review History: Received 6 October 2025; Reviewed 12 November 2025; Accepted 22 December; Available online 15 January 2026 Academic Editor: Dr. Muhammad Zahid Iqbal, AIMST University, Malaysia, drmmziqbal@gmail.com Reviewers: Dr. Mohammad Shaheen Khan, University Malaysia Sabah, Malaysia, shaheenchem@gmail.com Dr. Mahmoud S. Abdallah, University of Sadat city, Egypt, dr_samy777@yahoo.com