[Relationship between human immunodeficiency virus and sperm--implications in medically assisted procreation].
The number of HIV-sero-discordant couples (man HIV+, woman HIV-) asking for assisted reproductive technologies (ART) has been increasing more and more since the efficiency of antiretroviral therapy was clinically proven. Long-term survey and amelioration of life quality in treated HIV-seropositive patients have induced in these couples a strong wish to conceive but they expected the most reduced risk of viral contamination. Epidemiologic data concerning HIV transmission during episodic unprotected sexual acts showed an elevated annual seroconversion rate which justifies that since 1992, European biologists specialized in human reproduction have proposed to carry out ART using intrauterine insemination (IUI) with prepared sperm in the population of couples where the man is HIV-seropositive. In spite of adapted technologies of sperm preparation, presence of HIV nucleic acids was demonstrated in purified spermatozoon (SPZ) fractions, resulting from residual free virus or virus linked to SPZ or residual infected cells, not completely eliminated. However, approximatively 2000 IUI were carried out with an HIV-controlled sperm treatment and no female and newborn seroconversions were reported. Even if the total lack of risk is impossible to obtain, a strict method of infected sperm preparation associated with sensitive virological techniques should permit us to obtain a minimal risk of contamination of women after IUI. In vitro fertilization (IVF) with or without microinjection allowed us to obtain the same results but they should be confirmed by further studies to be more relevant. These European workings, associated to a clear legal regulation in France, permit us to considerate that carrying out ART in HIV-sero-discordant couples in which the man is HIV-seropositive is allowable regarding both the viral problem and eventual sterility.
Sifer
C
C
Service d'histologie-embryologie cytogénétique et biologie de la reproduction, Hôpital Bichat-Claude-Bernard, Paris, France.
Benifla
J L
JL
Devaux
A
A
Blanc-Layrac
G
G
Madelenat
P
P
Feldmann
G
G
D000328:Adult; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D012099:Reproductive Techniques; D013094:Spermatozoa / Q000821:virology*
Relations entre le virus de l'immunodéficience humaine et le sperme--implications dans l'aide médicale à la procréation.