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Abstract
Special program of assisted reproduction for HIV-infected men
A. Kiessling A.1, Desmarais B.1, Yin H.-Z.1, Eyre R.1, Steinberg J.1
1Bedford Research Foundation, Somerville, United States of America
Introduction: Assisted reproductive technologies (ART) can help HIV-infected men safely father children. But many ART programs are reluctant to treat HIV-infected men because of concerns about handling HIV-infected semen. A sensitive RT-PCR assay for virus and virus-infected cells allows eliminatiion of HIV-infected specimens and identification of specimens with an undetectable viral burden which can be shipped to ART clinics, thus eliminating concerns about handling infected specimens.
Methods: Semen specimens are overnight-shipped to the laboratory for testing. Part of the specimen is added to guanidium isothiocyanate at a concentration that lyses virus and non-sperm cells; HIVgag was detected by a triple bracket-nested RT-PCR assay that could detect 210 copies of viral RNA/ml semen, and/or one infected cell. Sperm, cryopreserved prior to testing, from specimens with an undetectable viral burden were shipped to ART clinics.
Results: From 1999 to June,2004,442 semen specimens from 133 men on successful anti-retroviral therapy were tested for HIV; 104 tested positive and were discarded. Men with two positive specimens in a row were further evaluated for prostatitis, or for modification of their anti-retroviral therapy. Sixty seven couples proceeded to ART, resulting in 29 pregnancies, 38 babies born, all mothers and babies tested negative for HIV antibody.
Conclusions: Testing semen for HIV can eliminate specimens with a detectable viral burden, and allow the use of tested specimens in ART clinics near the couples´ home. Moreover, adjusting treatment regimens of HIV-infected men to eliminate virus production by semen producing organs may also prevent disease progression.
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