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Sergouniotis F, Olofsson JI, Westling K, Rodriguez-Wallberg KA. First 15 Years of Assisted Reproductive Technology Using Washed Sperm in HIV-Positive Individuals Under Antiretroviral Therapy: Sweden's Nationwide Outcomes. AIDS Patient Care STDS 2023; 37:566-573. [PMID: 38096116 DOI: 10.1089/apc.2023.0163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
Antiretroviral therapy has made HIV a chronic infectious disease. In Sweden, assisted reproductive technologies using sperm washing were implemented in 2004 for treatment of all HIV-positive males in serodiscordant couples at Karolinska Hospital in Stockholm. This study aimed to assess efficacy and safety of this approach and to investigate the effect of antiretroviral regimens on sperm quality of men treated for HIV. The study included all HIV-positive men (n = 53) adherent to antiretroviral treatment, including nucleoside/nucleotide analog reverse-transcriptase inhibitors (NRTIs) combined with non-nucleoside reverse-transcriptase inhibitors (NNRTIs) in 22 cases, or with other medication in 31 cases wishing fertility treatment. Sperm was washed using gradient centrifugation with a double tube system, frozen and thawed. Thereafter, single spermatozoa were injected in oocytes by intracytoplasmic sperm injection (ICSI). Treatment outcomes were compared to those of hepatitis B virus (HBV)-seropositive men in serodiscordant couples (n = 56), undergoing similar sperm washing protocols and ICSI at the center. In total, 82 fresh and 39 frozen/thawed embryo transfer (FET) cycles were performed in discordant HIV couples and 92 fresh and 36 FET cycles in HBV. Fertilization rates (69.2% vs. 64.6%, p = 0.310), clinical pregnancy rates (39.2% vs. 32.6%, p = 0.378), and live birth rates (35.8% vs. 31.5%, p = 0.565) were similar between the groups and the cumulative results yielded similar outcomes with a live birth rate of 52.8% and 51.8% (p = 0.913), respectively. No post-wash sperm sample was found positive for HIV viral particles. No partner seroconversion or offspring infection was reported. NNRTI-treated men had significantly lower motile sperm concentration than non-NNRTI-treated patients (54.48% vs. 36.41%, p < 0001). This study showed that in vitro fertilization/ICSI treatment with sperm washing was safe in individuals compliant to antiretroviral treatment and the reproductive outcome was similar to that of HBV-positive men. The observed moderate negative impact on sperm motility of NNRTI regimens may be overcome by using ICSI.
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Affiliation(s)
- Fotios Sergouniotis
- Laboratory of Translational Fertility Preservation, Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Division of Gynecology and Reproduction, Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Jan I Olofsson
- Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Katarina Westling
- Division of Infectious Diseases and Dermatology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Kenny A Rodriguez-Wallberg
- Laboratory of Translational Fertility Preservation, Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Division of Gynecology and Reproduction, Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
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Managing and preventing blood-borne viral infection transmission in assisted reproduction: a Canadian Fertility and Andrology Society clinical practice guideline. Reprod Biomed Online 2020; 41:203-216. [PMID: 32546334 DOI: 10.1016/j.rbmo.2020.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 05/07/2020] [Indexed: 12/30/2022]
Abstract
Fertility care providers have an obligation to provide safe and effective care to patients. When a user of assisted reproductive technology (ART) is living with a blood-borne viral infection (BBVI: HIV, hepatitis C or hepatitis B), physicians and ART laboratory personnel need to know the requirements for providing quality care. Recent developments in the treatment of BBVI and understanding of transmission have changed these requirements. This guideline from the Canadian Fertility and Andrology Society (CFAS) provides comprehensive, evidence-based guidelines for reducing horizontal transmission and cross-contamination in the ART setting.
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Bell M, Edelstein M, Hurwitz S, Irwin R. Accessibility and availability of assistant reproductive technology for people living with HIV in Europe: a thematic literature review. AIDS Care 2019; 32:949-953. [PMID: 31875688 DOI: 10.1080/09540121.2019.1707471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
As antiretroviral therapies have transformed HIV into a manageable chronic disease, many individuals have or will choose to have children, and the use of assisted reproductive technology can serve as an effective risk-reducing strategy. In this thematic literature review, we examine the state of research on access to and availability of assisted reproductive health technologies for people living with HIV in Europe, with the aim of identifying gaps for further research. We find that the existing literature is focused on serodiscordant couples consisting of an HIV-positive man and an HIV-negative women. This is in part because more treatment options are available for men living with HIV than women, reflecting underlying gender discrimination in treatment. The existing scholarship largely ignores reproductive options for seroconcordant couples or single individuals, or for men and women with underlying infertility. Finally, very little research addresses the question of financial affordability, which is a known barrier to infertility treatment.
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Affiliation(s)
| | | | | | - Rachel Irwin
- DIS Study Abroad in Scandinavia, Stockholm, Sweden
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Zangeneh M, Sedaghat Jou M, Sadighi Gilani MA, Jamshidi Makiani M, Sadeghinia S, Salman Yazdi R. The prevalence of HBV, HCV and HIV infections among Iranian infertile couples referring to Royan institute infertility clinic: A cross-sectional study. Int J Reprod Biomed 2018. [DOI: 10.29252/ijrm.16.9.595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Pasquier C, Walschaerts M, Raymond S, Moinard N, Saune K, Daudin M, Izopet J, Bujan L. Patterns of residual HIV-1 RNA shedding in the seminal plasma of patients on effective antiretroviral therapy. Basic Clin Androl 2017; 27:17. [PMID: 28904798 PMCID: PMC5590187 DOI: 10.1186/s12610-017-0063-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 08/18/2017] [Indexed: 12/15/2022] Open
Abstract
Background More and more HIV-1-infected men on effective antiretroviral treatment (ART) have unprotected sex in order to procreate. The main factor influencing transmission is seminal HIV shedding. While the risk of HIV transmission is very low, it is difficult to assess in individuals. Nevertheless, it should be quantified. Results We retrospectively analysed seminal plasma HIV-1 shedding by 362 treated HIV-infected men attending a medically assisted reproduction centre (1998–2013) in order to determine its frequency, the impact of the antiretroviral regimen on HIV shedding, and to identify shedding patterns. The HIV-1 virus loads in 1396 synchronized blood and semen samples were measured, and antiretroviral treatment, biological and epidemiological data were recorded. We detected isolated HIV-1 shedding into the seminal plasma in 5.3% of patients on efficient antiretroviral treatment, but there was no association with the HIV antiretroviral drug regimen or the CD4 cell count. These men had undergone more regimen changes since treatment initiation and had been on the ongoing drug regimen longer than the non-shedding men. The patterns of HIV seminal shedding among patients with undetectable HIV blood virus load varied greatly. HIV seminal shedding can occur as long as 5 years after starting antiretroviral treatment. Conclusions The seminal HIV load was used to monitor risk for infertile HIV-infected patients on an assisted reproductive technology program. This can still be recommended for patients who recently (6 months) started ART, or those with a poor history of adherence to ART but may also be usefull for some patients during counselling. Residual HIV seminal shedding is probably linked to breaks in adherence to antiretroviral treatment but local genital factors cannot be ruled out.
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Affiliation(s)
- Christophe Pasquier
- INSERM U1043, CPTP, CHU Purpan, BP 3028, F-31024 Toulouse, France.,Université de Toulouse, UPS, CPTP, F-31024 Toulouse, France.,Laboratoire de Virologie, CHU de Toulouse, Hôpital Purpan, F-31059 Toulouse, France.,Laboratoire de Virologie, Institut Fédératif de Biologie, 330 avenue de Grande Bretagne, TSA40031, 31059, Cédex 9 Toulouse, France
| | - Marie Walschaerts
- Université de Toulouse, UPS, Groupe de Recherche en Fertilité Humaine (EA 3694, Human Fertility Research Group), Toulouse, France.,CECOS Midi-Pyrénées, Hôpital Paule-de-Viguier, Toulouse, France
| | - Stéphanie Raymond
- INSERM U1043, CPTP, CHU Purpan, BP 3028, F-31024 Toulouse, France.,Université de Toulouse, UPS, CPTP, F-31024 Toulouse, France.,Laboratoire de Virologie, CHU de Toulouse, Hôpital Purpan, F-31059 Toulouse, France
| | - Nathalie Moinard
- Université de Toulouse, UPS, Groupe de Recherche en Fertilité Humaine (EA 3694, Human Fertility Research Group), Toulouse, France.,CECOS Midi-Pyrénées, Hôpital Paule-de-Viguier, Toulouse, France
| | - Karine Saune
- INSERM U1043, CPTP, CHU Purpan, BP 3028, F-31024 Toulouse, France.,Université de Toulouse, UPS, CPTP, F-31024 Toulouse, France.,Laboratoire de Virologie, CHU de Toulouse, Hôpital Purpan, F-31059 Toulouse, France
| | - Myriam Daudin
- Université de Toulouse, UPS, Groupe de Recherche en Fertilité Humaine (EA 3694, Human Fertility Research Group), Toulouse, France.,CECOS Midi-Pyrénées, Hôpital Paule-de-Viguier, Toulouse, France
| | - Jacques Izopet
- INSERM U1043, CPTP, CHU Purpan, BP 3028, F-31024 Toulouse, France.,Université de Toulouse, UPS, CPTP, F-31024 Toulouse, France.,Laboratoire de Virologie, CHU de Toulouse, Hôpital Purpan, F-31059 Toulouse, France
| | - Louis Bujan
- Université de Toulouse, UPS, Groupe de Recherche en Fertilité Humaine (EA 3694, Human Fertility Research Group), Toulouse, France.,CECOS Midi-Pyrénées, Hôpital Paule-de-Viguier, Toulouse, France
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Loutfy MR, Margolese S, Money DM, Gysler M, Hamilton S, Yudin MH. Lignes directrices canadiennes en matière de planification de la grossesse en présence du VIH. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 38:S59-S78. [PMID: 28063568 DOI: 10.1016/j.jogc.2016.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bujan L, Pasquier C. People living with HIV and procreation: 30 years of progress from prohibition to freedom? Hum Reprod 2016; 31:918-25. [PMID: 26975324 DOI: 10.1093/humrep/dew036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 02/07/2016] [Indexed: 01/26/2023] Open
Abstract
The emergence of human immunodeficiency virus (HIV) infection in the 1980s drastically changed the prospects of conceiving a child for the man or woman infected with the virus. Advances in treatment then made it possible to envisage pregnancy while decreasing the risk of transmission to the child when the mother was infected. For couples where one partner was HIV-positive and who desired a child, recourse to medical help, notably medically assisted procreation, was discouraged, and very few centres offered such assistance in the 1980s and 1990s. Improved knowledge of viral excretion in the genital tracts, together with more effective treatment, made it possible to envisage medically assisted procreation for these couples, allowing them to have a child while at the same time likely reducing the risk of transmitting HIV to their partner. Several programmes have demonstrated their effectiveness in this domain. Owing to continually increasing knowledge over the past decade, natural conception can now be proposed. Couples where one or both partners are HIV-positive may opt for medically assisted procreation or natural reproduction. Specialists in reproductive medicine and HIV specialists need to provide couples with objective information allowing them to achieve near-optimal conditions that minimize HIV transmission risk. Couples will then be able to choose freely the mode of procreation most appropriate for them.
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Affiliation(s)
- L Bujan
- Université Toulouse-III Paul Sabatier, Groupe de Recherche en Fertilité Humaine (EA 3694, Human Fertility Research Group), Toulouse, France CECOS, Centre Hospitalier Universitaire Paule de Viguier, Toulouse, France
| | - C Pasquier
- INSERM U1043, CPTP, Centre Hospitalier Universitaire Toulouse-Purpan, BP 3028, F-31024 Toulouse, France Université Toulouse-III Paul Sabatier, CPTP, F-31024 Toulouse, France Laboratoire de Virologie, Centre Hospitalier Universitaire Toulouse-Purpan, F-31059 Toulouse, France
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Zafer M, Horvath H, Mmeje O, van der Poel S, Semprini AE, Rutherford G, Brown J. Effectiveness of semen washing to prevent human immunodeficiency virus (HIV) transmission and assist pregnancy in HIV-discordant couples: a systematic review and meta-analysis. Fertil Steril 2015; 105:645-655.e2. [PMID: 26688556 DOI: 10.1016/j.fertnstert.2015.11.028] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 11/16/2015] [Accepted: 11/17/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of semen washing in human immunodeficiency virus (HIV)-discordant couples in which the male partner is infected. DESIGN Systematic review and meta-analysis. SETTING Not applicable. PATIENT(S) Forty single-arm open-label studies among HIV-discordant couples that underwent intrauterine insemination (IUI) or in vitro fertilization (IVF) with or without intracytoplasmic sperm injection (ICSI) using washed semen. INTERVENTION(S) Semen washing followed by IUI, IVF, or IVF/ICSI. MAIN OUTCOME MEASURE(S) PRIMARY OUTCOME HIV transmission to HIV-uninfected women; secondary outcomes: HIV transmission to newborns and proportion of couples achieving a clinical pregnancy. RESULT(S) No HIV transmission occurred in 11,585 cycles of assisted reproduction with the use of washed semen among 3,994 women. Among the subset of HIV-infected men without plasma viral suppression at the time of semen washing, no HIV seroconversions occurred among 1,023 women after 2,863 cycles of assisted reproduction with the use of washed semen. Studies that measured HIV transmission to infants reported no cases of vertical transmission. Overall, 56.3% of couples (2,357/4,184) achieved a clinical pregnancy with the use of washed semen. CONCLUSION(S) Semen washing appears to significantly reduce the risk of transmission in HIV-discordant couples desiring children, regardless of viral suppression in the male partner. There are no randomized controlled studies or studies from low-income countries, especially those with a large burden of HIV. Continued development of lower-cost semen washing and assisted reproduction technologies is needed. Integration of semen washing into HIV prevention interventions could help to further reduce the spread of HIV.
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Affiliation(s)
- Maryam Zafer
- Global Health Sciences, University of California, San Francisco, California
| | - Hacsi Horvath
- Global Health Sciences, University of California, San Francisco, California
| | - Okeoma Mmeje
- Department of Obstetrics and Gynecology, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Sheryl van der Poel
- Division of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Augusto E Semprini
- Department of Clinical Sciences "L. Sacco", University of Milan School of Medicine, Milan, Italy
| | - George Rutherford
- Global Health Sciences, University of California, San Francisco, California
| | - Joelle Brown
- Global Health Sciences, University of California, San Francisco, California; Department of Obstetrics and Gynecology, University of Michigan School of Medicine, Ann Arbor, Michigan; Department of Epidemiology and Biostatistics and Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California.
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Abstract
Human immunodeficiency virus-serodiscordant couples are actively seeking reproductive assistance and often consider or practice unsafe measures to achieve pregnancy. Reproductive issues and concerns unique to these couples need to be addressed before treatment. Assisted reproduction techniques can minimize the risk of infection and complete families associated with serodiscordant couples. Since 1987, more than 4000 published attempts have been reported in which processed spermatozoa from HIV-seropositive men were used to establish pregnancy in HIV-seronegative women. When the female partner is HIV positive, intrauterine insemination (IUI) will suffice in order to prevent horizontal infection. However, when the male partner is HIV positive, a technique developed in Milan over 15 years ago, involving sperm washing, is used in order to minimize infection of the healthy partner. Some couples need further treatment, due to inherent infertility, with advanced reproductive technology (ART) procedures, such as IVF or ICSI. Recent innovative approaches such as pre-exposure prophylaxis (PrEP) with antiretroviral drugs may reduce further the susceptibility of the uninfected female partner. Numerous ART centers worldwide treat these couples. Most centers are equipped with separate laboratory space for collecting specimens from infected patients and provide separate storage tanks for freezing infected gametes and embryos in order to protect other patients using the facility. There are no reports of HIV infection of laboratory personnel resulting from processing the gametes/embryos for serodiscordant couples using current laboratory protocols. Cross-contamination of the gametes or embryos of other couples in the same laboratory has also not been reported. The risk is theoretical only, particularly when standard universal precautions are used.
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10
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Sullivan-Pyke CS, Nurudeen SK, Grossman LC, Sauer MV, Douglas NC. Fertility treatment options for HIV-infected individuals. Future Virol 2013. [DOI: 10.2217/fvl.13.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Many HIV-serodiscordant couples desire children and physician-assisted techniques can help individuals achieve pregnancy while reducing the risk of seroconversion in their seronegative partner. For HIV-seropositive males, sperm washing with intrauterine insemination (SW-IUI) was introduced in Europe in the early 1990s, while in the USA in vitro fertilization with intracytoplasmic sperm injection (IVF-ICSI) has been primarily used to reduce the risk of viral transmission. When properly applied to well-selected populations, no seroconversion has been reported with either of these methods. Within the last 5 years, randomized controlled studies have demonstrated the efficacy of daily pre-exposure prophylaxis in reducing the risk of seroconversion in couples having intercourse when an HIV-seropositive male has undetectable viral loads. In both the USA and Europe, favorable reproductive outcomes have been reported for HIV-seropositive females undergoing IUI and IVF-ICSI. Herein, we review the use of various contemporary reproductive techniques available to HIV-serodiscordant couples interested in having children, including new data on cumulative clinical pregnancy rates and cumulative live-birth rates after IVF-ICSI for male serodiscordant couples. We conclude by proposing that pre-exposure prophylaxis with SW-IUI may be a safe, economical and effective alternative for achieving pregnancy in well-selected, monogamous HIV-serodiscordant couples where the male partner is seropositive.
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Affiliation(s)
- Chantae S Sullivan-Pyke
- Columbia University, Department of OB-GYN, Division of Reproductive Endocrinology & Infertility, 622 W 168th Street, PH-16, New York, NY 10032, USA
| | - Sahadat K Nurudeen
- Columbia University, Department of OB-GYN, Division of Reproductive Endocrinology & Infertility, 622 W 168th Street, PH-16, New York, NY 10032, USA
| | - Lisa C Grossman
- Columbia University, Department of OB-GYN, Division of Reproductive Endocrinology & Infertility, 622 W 168th Street, PH-16, New York, NY 10032, USA
| | - Mark V Sauer
- Columbia University, Department of OB-GYN, Division of Reproductive Endocrinology & Infertility, 622 W 168th Street, PH-16, New York, NY 10032, USA
| | - Nataki C Douglas
- Columbia University, Department of OB-GYN, Division of Reproductive Endocrinology & Infertility, 622 W 168th Street, PH-16, New York, NY 10032, USA
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Semprini AE, Macaluso M, Hollander L, Vucetich A, Duerr A, Mor G, Ravizza M, Jamieson DJ. Safe conception for HIV-discordant couples: insemination with processed semen from the HIV-infected partner. Am J Obstet Gynecol 2013; 208:402.e1-9. [PMID: 23395921 DOI: 10.1016/j.ajog.2013.02.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 01/15/2013] [Accepted: 02/04/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The objective of the study was to evaluate the safety of semen washing with intrauterine insemination (SW-IUI) for achieving pregnancy when the man is human immunodeficiency virus (HIV) infected and the woman is HIV negative. STUDY DESIGN We conducted a retrospective analysis of 635 HIV-discordant couples enrolled in a SW-IUI program and followed up 367 Italian women. We computed pregnancy, live birth, and multiple delivery rates and assessed the women's postinsemination HIV status. RESULTS The retrospective analysis included 635 couples (2113 SW-IUI cycles): 41% of the women (95% confidence interval [CI], 37-45%) had a live birth (per-cycle live birth rate 13%; 95% CI, 11-14%). HIV status after SW-IUI was negative when available but unknown for 26% of the women: missing HIV status was not associated with correlates of HIV risk. The follow-up study included 367 couples (1365 cycles): 47% of the women (95% CI, 42-52%) had a live birth (per-cycle rate 14%; 95% CI, 12-16%). Ascertainment of postinsemination HIV status was complete and confirmed no HIV transmission attributable to SW-IUI. The upper 95% confidence limit of the HIV transmission rate was 1.8 per 1000 cycles in the retrospective analysis and 2.7 per 1000 cycles in the follow-up study. CONCLUSION SW-IUI appears to be a safe and effective method for achieving pregnancy in HIV-discordant couples in which the man is HIV infected.
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Rieg G. HIV: Identification, Diagnosis, and Prevention. Sex Transm Dis 2013. [DOI: 10.1007/978-1-62703-499-9_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Savasi V, Mandia L, Laoreti A, Cetin I. Reproductive assistance in HIV serodiscordant couples. Hum Reprod Update 2012; 19:136-50. [PMID: 23146867 DOI: 10.1093/humupd/dms046] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Three quarters of individuals infected with human immunodeficiency virus (HIV) are in their reproductive years and may consider pregnancy planning. Techniques have been developed which can minimize the risk of HIV transmission in these couples, and the current literature on this topic is reviewed here. METHODS We reviewed the literature for the following topics: risk of HIV transmission, effects of HIV infection on fertility, reproductive assistance in industrialized and low-income countries, pre-exposure chemoprophylaxis (PrEP) and timed intercourse in HIV-discordant couples for both male and female positivity. Relevant publications were identified through searches of the EMBASE Medline and PubMed databases, the Google-indexed scientific literature and periodic specialized magazines from the on-line Library Service of the University of Milan, Italy. RESULTS In serodiscordant couples in which the man is positive, the primary method used to prevent HIV transmission is 'sperm washing', followed by IUI or IVF. Data show that sperm washing in HIV-positive men has not produced seroconversion in women or their offspring; however, the evidence is limited. Recently, increasing evidence describing PrEP for HIV prevention has been published and PrEP could be an alternative to ART for fertile couples. Usually HIV-infected women undergo self-insemination around the time of ovulation. Few studies have been published on IVF outcome in HIV-infected women. CONCLUSIONS Assisted reproduction programmes should be integrated into global public health services against HIV. For HIV serodiscordant couples with infected men, sperm washing should be the first choice. However, timed intercourse and PrEP for HIV prevention has been reported. Recent data highlight the possible impairment of fertility in HIV-infected women. Efforts to design a multicentric study should be strengthened.
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Affiliation(s)
- V Savasi
- Unit of Obstetrics and Gynecology, Department of Clinical Sciences, Hospital L. Sacco, University of Milan, Via G. B. Grassi, 74, 20157 Milan, Italy.
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Treatment of human sperm with serine protease during density gradient centrifugation. J Assist Reprod Genet 2012; 29:1273-9. [PMID: 22956335 DOI: 10.1007/s10815-012-9851-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 08/08/2012] [Indexed: 10/27/2022] Open
Abstract
PURPOSE Seminal pathogens can bind specifically or non-specifically to spermatozoa, rendering semen decontamination procedures ineffective, whereby vertical or horizontal transmission of the infection could occur. Serine proteases have been demonstrated to effectively inactivate viruses and to break pathogen-sperm bonds. However, the addition of a protease to density gradient layers during semen processing could negatively impact on sperm parameters. This study investigated the effect of the addition of a recombinant, human-sequence protease (rhProtease) on sperm parameters during density gradient centrifugation. METHODS (i) Pooled semen samples (n = 9) were split and processed by density gradient centrifugation, with the top density layers supplemented, or non-supplemented with rhProtease at three different concentrations (diluted 2, 10 and 20 times). Sperm parameters were then analysed by flow cytometry and computer-assisted semen analyses. (ii) Semen samples (n = 5) were split and similarly processed using PureSperm® Pro, with rhProtease in the 40 % density gradient layer, or standard PureSperm® not supplemented with rhProtease (Nidacon, International) respectively. The Hemizona assay was then utilized to compare sperm-zona binding post processing. RESULTS Evaluation of sperm parameters indicated that rhProtease did not, at any of the tested concentrations, have an impact on (i) mitochondrial membrane potential, vitality, motility, or (ii) zona binding potential. CONCLUSION We report that the addition of rhProtease to density gradients is a non-detrimental approach that could improve the effectiveness of semen processing for the elimination of seminal pathogens, and benefit assisted reproduction outcome.
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Kehl S, Weigel M, Müller D, Gentili M, Hornemann A, Sütterlin M. HIV-infection and modern antiretroviral therapy impair sperm quality. Arch Gynecol Obstet 2011; 284:229-33. [DOI: 10.1007/s00404-011-1898-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 03/21/2011] [Indexed: 11/29/2022]
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Ahmad G, Moinard N, Jouanolou V, Daudin M, Gandia P, Bujan L. In vitro assessment of the adverse effects of antiretroviral drugs on the human male gamete. Toxicol In Vitro 2011; 25:485-91. [DOI: 10.1016/j.tiv.2010.11.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2010] [Revised: 11/14/2010] [Accepted: 11/26/2010] [Indexed: 10/18/2022]
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Systematic review of the effectiveness and safety of assisted reproduction techniques in couples serodiscordant for human immunodeficiency virus where the man is positive. Fertil Steril 2011; 95:1684-90. [PMID: 21324449 DOI: 10.1016/j.fertnstert.2011.01.127] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Revised: 12/20/2010] [Accepted: 01/10/2011] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the effectiveness and safety of assisted reproduction techniques (ART) in human immunodeficiency virus (HIV) serodiscordant couples. DESIGN Systematic review of five databases of noncomparative open intervention and observational studies of serodiscordant couples undergoing ART, with study selection and data extraction performed independently and in duplicate. SETTING Tertiary fertility centers. PATIENT(S) HIV serodiscordant couples where the man is HIV positive. INTERVENTION(S) Intrauterine insemination (IUI), in vitro fertilization (IVF), or intracytoplasmic injection (ICSI) performed after washed semen viral testing. MAIN OUTCOME MEASURE(S) Pregnancy rates per cycle, cumulative pregnancy, abortion rate, and HIV seroconversion in newborns or women. RESULT(S) Of the 658 abstracts retrieved, 41 were selected for review, and 17 full articles were included (3,900 IUI cycles in 1,184 couples in 11 aggregated studies and 738 ICSI/IVF cycles in 579 couples across 10 studies). The IUI and ICSI results were, respectively: pregnancy rates per cycle, 18% and 38.1%; cumulative pregnancy, 50% and 52.9%; and abortion rate, 15.6% and 20.6%. No seroconversions in women or newborns were detectable at birth or after 3 to 6 months. CONCLUSION(S) Cumulative evidence suggests that ART is safe and effective for avoiding horizontal and vertical transmission in HIV serodiscordant couples.
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Eke AC, Oragwu C. Sperm washing to prevent HIV transmission from HIV-infected men but allowing conception in sero-discordant couples. Cochrane Database Syst Rev 2011:CD008498. [PMID: 21249711 DOI: 10.1002/14651858.cd008498.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Sperm washing is a term used to describe the process in which individual spermatozoa are separated from the seminal fluid. Sperm washing is used to prevent HIV transmission but allow conception in sero-discordant couples, where the male is HIV positive, but the female is HIV negative. This procedure is based on the observation that HIV cannot attach itself to spermatozoa, but it can be found in the fluid and cells surrounding spermatozoa. OBJECTIVES To determine the benefits and harms of sperm washing of HIV-infected males when used to prevent the transmission of HIV but allowing conception in the HIV-negative female. SEARCH STRATEGY We searched the Cochrane HIV/AIDS Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, SCORPUS, AIDsearch, AJOL, LILACS and INDEX MEDICUS. We also searched the following conference proceedings for relevant abstracts:The International AIDS Conference; The Conference on Retroviruses and Opportunistic Infections (CROI); The British HIV Association (BHIVA) Conference; The International Conference of Obstetricians and Gynecologists (FIGO); The American Academy of HIV Medicine Conference; The Australasian HIV/AIDS Conference; The American Society for Reproductive Medicine (ASRM) conferences and website; The European Society for Human Reproduction and Embryology (ESHRE) conferences and websites, and the British Fertility Society (BFS) conferences and website. We also conducted a search of the website: www.ClinicalTrials.gov. The date of the most recent Cochrane HIV/AIDS Group Controlled Trials Register search was on the 10th of November, 2010. SELECTION CRITERIA We preferentially looked for randomised or quasi-randomised controlled trials on sperm washing, aimed at preventing HIV transmission from HIV infected men but allowing conception in sero-discordant couples, irrespective of publication status, year of publication, or language in the review. DATA COLLECTION AND ANALYSIS No relevant trials were identified for inclusion in this review. MAIN RESULTS Forty four studies were identified, but none of them were suitable for inclusion in this review. AUTHORS' CONCLUSIONS Reports on the use of sperm washing to prevent HIV transmission from HIV infected men but allowing conception in sero-discordant couples is currently limited to observational studies. No randomised controlled trial has assessed the benefit or risk of sperm washing to prevent HIV transmission from HIV infected men but allow conception in sero-discordant couples. Thus, this systematic review identifies the need for a multicentre randomised controlled trial assessing the benefits and possible risks of sperm washing in preventing HIV transmission from HIV infected men but allow conception in sero-discordant couples.
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Affiliation(s)
- Ahizechukwu C Eke
- Department of Health Policy and Management, Masters in Public Health (MPH), Harvard School of Public Health (HSPH), 677 Huntington Avenue, Boston, Massachusetts, USA, 02115
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Lorusso F, Palmisano M, Chironna M, Vacca M, Masciandaro P, Bassi E, Selvaggi Luigi L, Depalo R. Impact of chronic viral diseases on semen parameters. Andrologia 2010; 42:121-6. [PMID: 20384803 DOI: 10.1111/j.1439-0272.2009.00970.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The aim of this study was to assess the effect of human immunodeficiency virus (HIV), hepatitis C (HCV) and B (HBV) virus infection on semen parameters. Semen samples were obtained from 27 HCV, 34 HIV, 30 HBV and 41 HCV-HIV-seropositive patients and compared with those of a control population of healthy seronegative subjects. Tests for detection of HIV, HCV and HBV were performed on seminal samples. The sperm concentration was significantly decreased in HCV- and HBV-seropositive males compared to that of controls (P < 0.001). The mean sperm motility (a + b) was significantly decreased in HCV- and HBV-seropositive (P < 0.001) and in HCV-HIV-seropositive subjects (P < 0.05) compared to that of controls. The sperm viability was significantly lower in HCV- and HBV-seropositive men than in controls (P < 0.001). The normal morphology was significantly reduced in HCV-seropositive and HBV-seropositive men (P < 0.05) with respect to that of controls (P < 0.05). The sperm concentration after sperm wash was significantly higher in controls than in HCV-, HIV-, HBV- and HIV-HCV-seropositive men (P < 0.001). We can conclude that HBV- and HCV-infected men have a significantly impaired sperm quality compared with that of controls. The reason for the better sperm quality in our series of HIV- and HCV-HIV-infected men is still under debate. Further investigations in a larger case series are warranted.
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Affiliation(s)
- F Lorusso
- Department of Gynaecology, Obstetrics and Neonatology, University of Bari, Bari, Italy.
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21
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[Assisted reproductive technologies for serodiscordant couples: desire for child and pregnancy versus the fact of illness]. ACTA ACUST UNITED AC 2009; 38:58-69. [PMID: 20022790 DOI: 10.1016/j.gyobfe.2009.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Accepted: 05/05/2009] [Indexed: 11/20/2022]
Abstract
Assisted Reproductive Technologies for serodiscordant couples with HIV-infected male partner has been possible since 2000 in French centres such as the CECOS in Toulouse. From the outset, couples in the program meet psychologists or psychiatrists. In the first instance, the results from 40 psychologist led interviews with serodiscordant couples held at the CECOS in Toulouse, identified several challenging ideas. Couples who plan to have children were in a stable long-term relationship and both were involved in managing the illness. Medically assisted procreation awakens in the women a strong desire for children and enables the couples to make plans for the future. But it also reminds the men of their reliance on medical assistance because of the demands made by the medical program, and in case of failure it can destabilise the couples' way of coping with HIV. Subsequently, interviews with 12 couples during pregnancy revealed the overbearing presence of the illness, despite the imminent birth of the desired child. In their responses, women express their anxiety concerning the risk of contamination, and the defences that the men had built up to cope with HIV appeared destabilised, now that the idea of their death is rekindled.
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Savasi V, Ferrazzi E, Fiore S. Reproductive assistance for infected couples with bloodborne viruses. Placenta 2008; 29 Suppl B:160-5. [PMID: 18790329 DOI: 10.1016/j.placenta.2008.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2008] [Revised: 08/07/2008] [Accepted: 08/07/2008] [Indexed: 11/25/2022]
Abstract
During the past 15 years Assisted Reproduction has been facing a new demand from patients requiring ART: couples at risk of partner to partner, and mother to child transmission of viral infections, mainly HIV-1, HCV and HIV-HCV co-infected partners. The general conditions and life expectancy of many patients with HIV infection are very good, and three-quarters of these individuals are in their reproductive years. For these reasons, a large number of young couples are expected to make future plans to have children. This desire is not easy to realize for serodiscordant couples, if we consider that, in order to avoid HIV virus transmission, it is necessary to encourage the condom use in vaginal and anal contacts. On the other hand infertile discordant HCV couples need to be included in protocols of controlled assisted reproduction procedures to avoid any risk of HCV transmission to the partner. In this paper we consider assisted reproduction in discordant couples for HIV or HCV-positive men.
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Affiliation(s)
- V Savasi
- Department of Obstetrics and Gynaecology, Sacco Clinical Sciences Institute, University of Milan Medical School, Via GB Grassi 74, 20157 Milan, Italy.
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Abstract
PURPOSE OF REVIEW The total number of people living with HIV has reached 39.5 million. In developed countries, the major risk for HIV transmission is by heterosexual intercourse. The general condition and life expectancy of many patients with HIV infection is very good, and three-quarter of these individuals are in their reproductive years. For these reasons a large number of young couples are expected to make future plans to have children. Assisted reproduction in HIV-1 discordant couples has become important for clinicians in preventing HIV-1 transmission. RECENT FINDINGS The main theme covered in this article is epidemiology of HIV-1 in the world, the biology of the virus present in the sperm, the recently published guidelines from the American Society for Reproductive Medicine and ethics recommendations concerning assisted reproduction in people infected by virus, and all clinical aspects and scientific data published that have been modified to allow assisted reproduction in HIV-serodiscordant couples. SUMMARY To evaluate in clinical practice the safety of HIV-1 assisted reproduction with sperm washing and the outcome of assisted reproductive technologies offered to HIV-1 serodiscordant couples counselled for the prevention of HIV transmission.
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Aide médicale à la procréation chez les personnes infectées par le VIH. Presse Med 2008; 37:998-1006. [DOI: 10.1016/j.lpm.2007.06.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2006] [Revised: 06/22/2007] [Accepted: 06/26/2007] [Indexed: 11/24/2022] Open
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Restricting access of human immunodeficiency virus (HIV)-seropositive patients to infertility services: a legal analysis of the rights of reproductive endocrinologists and of HIV-seropositive patients. Fertil Steril 2008; 88:1483-90. [PMID: 18078847 DOI: 10.1016/j.fertnstert.2007.09.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2007] [Accepted: 09/10/2007] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To discuss the legal rights of reproductive endocrinologists and HIV-seropositive patients seeking infertility services. DESIGN Westlaw and LexisNexis commercial legal search engines were used to perform a legal review of statutes and cases pertaining to HIV-seropositive patients seeking health care services. CONCLUSION(S) Human immunodeficiency virus antidiscrimination laws apply to healthcare providers whether they practice in private clinics or a university setting. Patients infected with HIV cannot be denied access to health services solely on the basis of their HIV status. If proof exists that HIV-seropositive patients will medically benefit by a referral to another provider with more expertise, it is legally permissible to refer these patients to another provider who has more expertise in providing infertility services to HIV-seropositive patients. However, the burden will be on the reproductive endocrinologist to demonstrate that he or she lacks the capability to care for HIV-seropositive patients and that the referral was for the medical benefit of the patient and of the patient's potential offspring.
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Melo MAB, Meseguer M, Bellver J, Remohí J, Pellicer A, Garrido N. Human immunodeficiency type-1 virus (HIV-1) infection in serodiscordant couples (SDCs) does not have an impact on embryo quality or intracytoplasmic sperm injection (ICSI) outcome. Fertil Steril 2008; 89:141-50. [PMID: 17669407 DOI: 10.1016/j.fertnstert.2007.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2006] [Revised: 02/02/2007] [Accepted: 02/02/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the embryo quality in our program for human immunodeficiency type-1 virus (HIV-1) serodiscordant couples (SDCs) with the male infected in comparison with a tubal-factor infertility control group. DESIGN Retrospective case-control study. SETTING Instituto Valenciano de Infertilidad, Valencia, Spain. PATIENT(S) Thirty SDC and 79 control couples without HIV-1 infection attending for intracytoplasmic sperm injection (ICSI). Only first cycles were considered. INTERVENTION(S) Controlled ovarian hyperstimulation and ICSI in both groups; sperm wash, nested polymerase chain reaction (PCR) in semen sample, and capacitation by swim-up after thawing the semen sample in the SDC group; and sperm capacitation by swim-up after thawing the semen sample in the control group. MAIN OUTCOME MEASURE(S) ICSI procedure and embryo characteristics (fertilization, cleavage, embryo morphology, and development) and cycle outcome (ongoing pregnancy and miscarriage rates). RESULT(S) Fertilization and cleavage rates were similar between the groups. On days 2 and 3 of embryo development, very similar embryo features were found between the groups. There was no difference in mean number of optimal embryos on day 3. When embryos were cultured up to 5-6 days, a significant increase in embryo blockage was found in the SDC group compared with the control group. The mean number of optimal blastocysts on day 6 was comparable in both groups. No difference was found regarding the number of cryopreserved and transferred embryos or implantation, pregnancy, multiple pregnancy, or miscarriage rates between the groups. CONCLUSION(S) HIV-1 infection in SDCs with infected males does not appear to have a significantly negative impact on embryo development or ICSI outcome.
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Bujan L, Sergerie M, Kiffer N, Moinard N, Seguela G, Mercadier B, Rhone P, Pasquier C, Daudin M. Good efficiency of intrauterine insemination programme for serodiscordant couples with HIV-1 infected male partner: A retrospective comparative study. Eur J Obstet Gynecol Reprod Biol 2007; 135:76-82. [PMID: 17544201 DOI: 10.1016/j.ejogrb.2007.04.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2006] [Revised: 02/08/2007] [Accepted: 04/23/2007] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Assisted reproduction techniques can minimize the risk of HIV female contamination when the male partner is HIV-infected. The aim of this study was to investigate the efficiency of sperm washing and intrauterine insemination (IUI) in these couples. STUDY DESIGN Retrospective comparative study. Eighty-four HIV-1 serodicordant couples underwent 294 IUI. The control group was composed of 90 couples (320 IUI cycles) with donor sperm. Spermatozoa from HIV-1 infected male partner were prepared and tested for HIV-1 according to sperm washing method. Spermatozoa from HIV-1 and donor male were frozen before IUI. IUI were performed after ovarian stimulation. Main outcomes measures were pregnancy rate per cycle and baby take-home rate per couples. RESULTS Although the pregnancy rate and baby take-home rate were higher in IUI with sperm washing than in IUI using donor sperm (18.0 versus 14.7 and 52.4 versus 41.1, respectively), the differences were not statistically significant. In serodiscordant couples, blood estradiol levels under ovarian stimulation and total motile sperm inseminated were a determining factor in achieving pregnancy. No female HIV-1 contamination occurred. CONCLUSION This study demonstrates that sperm washing and IUI are highly effective in enabling serodiscordant couples with an HIV-1 infected male partner to have a child.
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Affiliation(s)
- Louis Bujan
- Université Toulouse-III Paul Sabatier, EA 3694, Research Group on Human Fertility, France.
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Ohl J, Partisani M. Désir d'enfant et infections virales: hépatites C et B et virus de l'immunodéficience humaine. ACTA ACUST UNITED AC 2007; 35:1035-8. [PMID: 17897865 DOI: 10.1016/j.gyobfe.2007.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2007] [Accepted: 06/26/2007] [Indexed: 11/26/2022]
Abstract
The French law (arrêté du 10 mai 2001) allows Assisted Reproductive Techniques (ART) in case of infection with human immunodeficiency virus, hepatitis C virus or hepatitis B virus. Our six years' experience is positive even if pluridisciplinary care needs specific equipment and human forces. Couples express high motivation. The wish to become a parent leads to a better care of the infection. ART results are excellent in case of male contamination, not as good when the female partner is infected but still encouraging. No contamination of the partner or the offspring occurred after ART. Data are already collected in France in this context. A European register should be constituted in an early future.
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Affiliation(s)
- J Ohl
- Centre d'Assistance médicale à la procréation de Strasbourg, CMCO-SIHCUS, 19, rue Louis-Pasteur, 67300 Schiltigheim, France.
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Bujan L, Hollander L, Coudert M, Gilling-Smith C, Vucetich A, Guibert J, Vernazza P, Ohl J, Weigel M, Englert Y, Semprini AE. Safety and efficacy of sperm washing in HIV-1-serodiscordant couples where the male is infected: results from the European CREAThE network. AIDS 2007; 21:1909-14. [PMID: 17721098 DOI: 10.1097/qad.0b013e3282703879] [Citation(s) in RCA: 157] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To examine the safety and effectiveness of assisted reproduction using sperm washing for HIV-1-serodiscordant couples wishing to procreate where the male partner is infected. DESIGN AND METHODS A retrospective multicentre study at eight centres adhering on the European network CREAThE and involving 1036 serodiscordant couples wishing to procreate. Sperm washing was used to obtain motile spermatozoa for 3390 assisted reproduction cycles (2840 intrauterine inseminations, 107 in-vitro fertilizations, 394 intra-cytoplasmic sperm injections and 49 frozen embryo transfers). An HIV test was performed in female partners at least 6 months after assisted reproduction attempt. The outcome measures recorded were number of assisted reproduction cycles, pregnancy outcome and HIV test on women post-treatment. RESULTS A total of 580 pregnancies were obtained from 3315 cycles. Pregnancy outcome was unknown in 47 cases. The 533 pregnancies resulted in 410 deliveries and 463 live births. The result of female HIV testing after assisted reproduction was known in 967 out of 1036 woman (7.1% lost to follow-up). All tests recorded were negative. The calculated probability of contamination was equal to zero (95% confidence interval, 0-0.09%). CONCLUSION This first multicentre retrospective study of assisted reproduction following sperm washing demonstrates the method to be effective and to significantly reduce HIV-1 transmission risk to the uninfected female partner. These results support the view that assisted reproduction with sperm washing could not be denied to serodiscordant couples in developed countries and, where possible, could perhaps be integrated into a global public health initiative against HIV in developing countries.
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Affiliation(s)
- Louis Bujan
- University Toulouse III Paul Sabatier, EA 3694, Research Group on Human Fertility, Toulouse, France.
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Daudin M, Bujan L. [Assisted reproductive care in serodiscordant couples whose man is infected with HIV]. ACTA ACUST UNITED AC 2007; 35:904-11. [PMID: 17719826 DOI: 10.1016/j.gyobfe.2007.07.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2007] [Accepted: 07/31/2007] [Indexed: 11/25/2022]
Abstract
Serodiscordant couples whose man is infected by human immunodeficiency virus have actually induced sterility by condom use. Since 2001, in France, assisted reproduction in serodiscordant couples has been facilitated thanks to the decree of 10th May 2001. In spite of the immense social and scientific advances in Assisted Reproductive Techniques, in such couples, limitation of care remains in certain cases. This study reviews current practices in France and other countries. Limits due to present reproductive and virological methods or legal conditions are underlined. In agreement with current scientific knowledge we suggest new modalities of reproductive care in serodiscordant couples with HIV infected men.
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Affiliation(s)
- M Daudin
- CECOS Midi-Pyrénées, hôpital Paule-de-Viguier, 330, avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse cedex 09, France.
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Kuji N, Mizusawa Y, Naganishi M, Hamatani T, Iwata S, Yoshimura Y. Elimination of HIV-1 from semen and application of the processed semen to assisted reproductive technology. Reprod Med Biol 2007; 6:151-156. [PMID: 29699272 DOI: 10.1111/j.1447-0578.2007.00178.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
As HIV infection is becoming a controllable chronic infection after the introduction of the highly active antiretroviral therapy (HAART), patients with this infection are now able to make plans for the future. Numerous serodiscordant (HIV-positive men and HIV-negative women) couples seek medical assistance to have a child with minimum risk to the HIV-negative female partner and the child using processed (washed) sperm. HIV-1 elimination from the semen using density gradient centrifugation and the swim-up procedure, which is a standard processing procedure, depends on both sperm motility and the physical properties of the virus-containing particles. To establish a simple method for recovering sperm from poor quality semen, we developed the tilted-tube rotation method to generate a continuous density gradient, and using this continuous density gradient we have succeeded in recovering motile sperm, even from the semen of seropositive males with severe male factors. This review aims to summarize the recent progress in the underlying principles and technical aspects of semen processing for elimination of HIV-1. (Reprod Med Biol 2007; 6: 151-156).
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Affiliation(s)
- Naoaki Kuji
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Yuri Mizusawa
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Miwa Naganishi
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Toshio Hamatani
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Sokichi Iwata
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Yasunori Yoshimura
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
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Savasi V, Ferrazzi E, Lanzani C, Oneta M, Parrilla B, Persico T. Safety of sperm washing and ART outcome in 741 HIV-1-serodiscordant couples. Hum Reprod 2006; 22:772-7. [PMID: 17107974 DOI: 10.1093/humrep/del422] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND To evaluate the safety of sperm washing and assisted reproduction technique (ART) outcome offered to serodiscordant couples with a human immunodeficiency virus-1 (HIV-1)-positive male. METHODS Sperm washing was performed and checked by RT-PCR on each semen sample before its fresh usage. Intrauterine insemination (IUI) or IFV/ICSI was offered according to fertility profile of each couple. Non-infected women underwent HIV testing 2 weeks before each procedure and for up to 6 months after. RESULTS Seven hundred and forty-one couples entered the study of a possible 2011 serodiscordant couples counselled over 4 years. Superovulation and IUI were performed in 581 couples, where the pregnancy rate per cycle and pregnancy rate per couple were 19 and 78%, respectively, with multiple pregnancy rate being 4%. One hundred and sixty couples were treated by IVF/ICSI, where pregnancy rate per cycle and per couple were 22 and 41%, respectively, with multiple pregnancy rate being 10%. All female partners were still HIV-1 negative at follow-up. CONCLUSION Sperm washing within a programme of reproductive counselling was proved to be safe in this large series of serodiscordant couples. The overall pregnancy rate (70.3%), independent of the procedure used (IUI or IVF/ICSI), justifies the effort of the medical team in setting up and implementing dedicated centres and of the individual patient in seeking a safe pregnancy.
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Affiliation(s)
- V Savasi
- Department of Obstetrics and Gynaecology, Sacco Clinical Sciences Institute, University of Milan Medical School, Milan, Italy
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van Leeuwen E, Prins JM, Jurriaans S, Boer K, Reiss P, Repping S, van der Veen F. Reproduction and fertility in human immunodeficiency virus type-1 infection. Hum Reprod Update 2006; 13:197-206. [PMID: 17099206 DOI: 10.1093/humupd/dml052] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Human immunodeficiency virus type-1 (HIV-1) affects mostly men and women in their reproductive years. For those who have access to highly active antiretroviral therapy (HAART), the course of HIV-1 infection has shifted from a lethal to a chronic disease. As a result of this, many patients with HIV-1 consider having offspring, as do other patients of reproductive age with chronic illnesses. This article summarizes the current knowledge on the presence of HIV in the male and female genital tract, the effects of HIV-1 infection and HAART on male and female fertility and the results of various assisted reproduction techniques (ART) in HIV-1-infected men and women who wish to have offspring.
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Affiliation(s)
- E van Leeuwen
- Department of Obstetrics and Gynaecology, Centre for Reproductive Medicine, Academic Medical Centre, Amsterdam, The Netherlands.
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Pasquier C, Souyris C, Moinard N, Bujan L, Izopet J. Validation of an automated real-time PCR protocol for detection and quantitation of HIV and HCV genomes in semen. J Virol Methods 2006; 137:156-9. [PMID: 16844236 DOI: 10.1016/j.jviromet.2006.05.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2006] [Revised: 05/23/2006] [Accepted: 05/25/2006] [Indexed: 11/18/2022]
Abstract
The ability to detect and quantify HIV and HCV genomes is important for checking spermatozoid preparation protocols also known as "sperm washing". But no commercial assay is available. A method was developed for detecting HIV and HCV in semen fractions using the COBAS Ampliprep and COBAS Taqman instruments. It will detect fewer than 200 copies of HIV RNA per ml of semen plasma and fewer than 200 copies/3 x 10(6) semen cells. The sensitivity for HCV is similar at more than 200 IU/ml and below 200 IU/3 x 10(6) semen cells. No inhibitor of PCR amplification was detected. This automated protocol permits a convenient, standardized testing for HIV and HCV in semen. The performance is the same as that of the previous generation of automated assays but the cost and operating time are both reduced.
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Affiliation(s)
- Christophe Pasquier
- Laboratoire de Virologie, EA2046-IFR30, Hôpital Purpan, 31059 Toulouse, France.
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35
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Gilling-Smith C, Nicopoullos JDM, Semprini AE, Frodsham LCG. HIV and reproductive care—a review of current practice. BJOG 2006; 113:869-78. [PMID: 16753050 DOI: 10.1111/j.1471-0528.2006.00960.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In developed countries, antiretroviral treatment has increased life quality and expectancy of HIV-infected individuals and led to a drop in mother-to-child transmission (MCT) risk to below 1%. Fertility has been shown to be reduced in both men and women with HIV. As a result of these factors, the demand for reproductive care in this population is rising. In discordant couples where the man is positive, sperm washing significantly reduces viral transmission risk to the uninfected female partner over unprotected intercourse. Positive women do not necessarily need specialised fertility treatment but should be monitored closely during pregnancy to minimise MCT risk.
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Affiliation(s)
- C Gilling-Smith
- Assisted Conception Unit, Chelsea & Westminster Hospital, London, UK.
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Bujan L, Daudin M, Pasquier C. Choice of ART programme for serodiscordant couples with an HIV infected male partner. Hum Reprod 2006; 21:1332-3; author reply 1333-4. [PMID: 16611978 DOI: 10.1093/humrep/dei472] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Many HIV-infected individuals are in relationships with HIV-uninfected partners and desire to have children. This review focuses on the issue of reproductive choices for these couples, in particular assisted reproductive technologies, and summarises the published outcome data currently available. The results thus far from assisted reproductive technologies in optimising pregnancy outcomes and reducing heterosexual and perinatal HIV transmission are promising. In the future, it is essential that there is ongoing reporting of outcome data, publication of methodology and follow-up, and reporting of adverse outcomes.
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Affiliation(s)
- Michelle Giles
- Macfarlane Burnet Institute for Medical Research and Public Health, GPO Box 2284, Melbourne, VIC 3001, Australia.
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Martinet V, Manigart Y, Rozenberg S, Becker B, Gerard M, Delvigne A. Ovarian response to stimulation of HIV-positive patients during IVF treatment: a matched, controlled study. Hum Reprod 2006; 21:1212-7. [PMID: 16439503 DOI: 10.1093/humrep/dei493] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Our aim was to compare the ovarian response of HIV-positive and -negative patients during IVF. METHODS Setting - HIV and IVF reference university hospital. Twenty-seven HIV-infected patients who had undergone IVF between March 2000 and March 2005 were matched with 77 HIV-negative patients for age, aetiology of infertility, whether it was primary or secondary infertility, duration of infertility, history of pelvic surgery and type of pituitary inhibition. Outcome - poor responders were defined using one of the following criteria: a cancelled cycle (for insufficient ovarian response), less than four mature follicles (> or = 16 mm), peak serum levels of E2 lower than 1000 pg/ml. RESULTS There were no differences between the two groups of patients for the matched criteria. The proportion of African women and of women with a history of pelvic inflammatory disease was significantly higher among HIV patients than among the control group. With the exception of a lower number of transferred embryos among HIV-positive patients versus HIV-negative ones (1.3 versus 1.9; P = 0.035), there was no significant difference between the two groups of patients regarding ovarian response parameters. CONCLUSION HIV-infected patients who are in good general condition and who are matched to a control group present a similar ovarian response to stimulation, suggesting the existence of a similar ovarian reserve.
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Affiliation(s)
- Valérie Martinet
- Department of Obstetrics and Gynaecology, Division of Infectious Diseases, CHU Saint-Pierre, Université Libre de Buxelles, Brussels, Belgium
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HIV Infection and AIDS. Sex Transm Dis 2006. [DOI: 10.1007/978-1-59745-040-9_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Pasquier C, Anderson D, Andreutti-Zaugg C, Baume-Berkenbosch R, Damond F, Devaux A, Englert Y, Galimand J, Gilling-Smith C, Guist'hau O, Hollander L, Leruez-Ville M, Lesage B, Maillard A, Marcelin AG, Schmitt MP, Semprini A, Vourliotis M, Xu C, Bujan L. Multicenter quality control of the detection of HIV-1 genome in semen before medically assisted procreation. J Med Virol 2006; 78:877-82. [PMID: 16721844 DOI: 10.1002/jmv.20636] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Couples in whom the man is HIV-1-positive may use medically assisted procreation in order to conceive a child without contaminating the female partner. But, before medically assisted procreation, the semen has to be processed to exclude HIV and tested for HIV nucleic acid before and after processing. The performance was evaluated of the technical protocols used to detect and quantify HIV-1 in 11 centers providing medically assisted procreation for couples with HIV-1 infected men by testing panels of seminal plasma and cells containing HIV-1 RNA and/or DNA. The performance of these tests varied due to the different assays used. False positive results were obtained in 14-19% of cases. The sensitivity for RNA detection in seminal plasma was 500-1,000 RNA copies/ml, over 500 RNA copies/10(6) cells in semen cells, and for DNA detection in semen cells 50-500 DNA copies/10(6) cells. The use of silica-based extraction seemed to increase the assay performance, whereas the use of internal controls to detect PCR inhibitor did not. This first quality control highlights the need for technical improvements of the assays to detect and quantify HIV in semen fractions and for regular evaluation of their performance.
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Affiliation(s)
- Christophe Pasquier
- Laboratoire de Virologie, laboratoire de Spermiologie et CECOS Midi-Pyrénées, Toulouse University Hospital, Toulouse, France.
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Honeck P, Weigel M, Kwon ST, Alken P, Bross S. Assisted procreation in cases of hepatitis B, hepatitis C or human immunodeficiency virus infection of the male partner. Hum Reprod 2005; 21:1117-21. [PMID: 16361281 DOI: 10.1093/humrep/dei459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Guidelines for assisted procreation impose a special responsibility upon physicians for the health of the expected child because of their active role in inducing pregnancy. Therefore, careful clinical evaluation of both partners has to precede every application of these methods. Risks for the mother's health or the development of the child count as a relative contraindication for a treatment. To balance these relative contraindications, the existing risk factors have to be recognized through screening examination. If a chronic infection occurs in the male partner, prevention for the female partner is theoretically possible by using a condom. As this inhibits a pregnancy, at least in cases of human immunodeficiency virus and hepatitis C virus infections, realization of a pregnancy requires assisted procreation. The main question in these cases is whether infectious particles can be eliminated by sperm processing to ensure the safe treatment of the healthy female partner.
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Affiliation(s)
- P Honeck
- Department of Urology, University Hospital of Mannheim, Mannheim, Germany.
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Andréoletti L, Piednoir E, Legoff J, Brodard V, Beguinot I, Strady C, Rouger C, Piketty C, Si-Mohamed A, Kazatchkine MD, Malkin JE, Bélec L. High seroprevalence of herpes simplex virus type 2 infection in French human immunodeficiency virus type 1-infected outpatients. J Clin Microbiol 2005; 43:4215-7. [PMID: 16081982 PMCID: PMC1233922 DOI: 10.1128/jcm.43.8.4215-4217.2005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Using commercially available herpes simplex virus (HSV) type-specific serological diagnostic tests, HSV type 2 (HSV-2) antibody prevalence was assessed in two parallel prospective studies including 534 human immunodeficiency virus type 1 (HIV-1)-infected outpatients living in two areas of northern France. In the first cohort of 434 subjects, 223 (51%) individuals demonstrated a positive HSV-2 serological status while 66 (66%) of 100 subjects in the second cohort were seropositive for HSV-2 (51 versus 66%; P = 0.08). Among the 223 HSV-2-seropositive subjects identified in the first study cohort, only 22 (10%) had suffered from recurrent anogenital lesions during the past 12 months while 154 (69%) had no clinical history of herpesvirus infection. Our findings demonstrate high proportions of subclinical and undiagnosed HSV-2 infection in HIV-1-infected individuals and suggest that HSV type-specific serological testing in the French HIV-1-infected subpopulation could be an efficient strategy to diagnose clinically asymptomatic HSV-2 infections.
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Affiliation(s)
- Laurent Andréoletti
- Unité de Virologie Médicale, Unité d'Hygiène Hospitalière et Service des Maladies Infectieuses, Hôpital Robert Debré, Centre Hospitalo-Universitaire de Reims, and IFR-53/EA-3798, Faculté de Médecine de Reims, Reims, France.
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Pasquier C, Daudin M, Berrebi A, Izopet J, Bujan L. [HIV risk and procreation, how to reduce HIV and HCV transmission risk for serodiscordant couples?]. Med Mal Infect 2005; 35 Suppl 2:S26-7. [PMID: 15978377 DOI: 10.1016/s0399-077x(05)80183-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- C Pasquier
- Laboratoire de Virologie, Hôpital Purpan, CHU de Toulouse, TSA 40031, 31059 Toulouse, France
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