Assisted Reproduction in Hiv and HCV Infected Men of Serodiscordant Couples

Abstract

In serodifferent couples, there is a significant risk of sexual transmission of HIV, while the risk of transmitting HCV is minor. That said, the whole of the ejaculate is not necessarily infected and, therefore, hazardous. A careful dissection of its components by which motile sperm is separated and subsequently analyzed to verify the absence of viral elements could allow these couples a safer access to the reproductive process. The development in the field of assisted reproduction of new laboratory techniques and reliable tests for confirming the presence of both viruses in semen have led to the achievement of pregnancies while avoiding the infection of the seronegative partner and offspring. The system of detection is often performed by means of RT-PCR methods. These protocols are sensitive, but the presence of polymerase inhibitors in semen interferes with the reactions, yielding a high number of false negatives or undetermined results. HIV affects sperm quality only in the most advanced stages of the disease, while the fertility of asymptomatic or mild symptomatic patients is not affected by the disease. This review explores the possibilities offered by assisted reproduction and molecular biology techniques to HIV and/or HCV serodiscordant couples by which they may conceive children with the minimum risk.

Impact of freezing/thawing technique on sperm DNA integrity in HIV-1 patients

“…In our study, sperm was bacteria-free in both groups before cryopreservation, and the leukocyte count was under the WHO threshold (<1 million/ml). 3-Sperm characteristics were similar in our two groups, as has been previously demonstrated in treated patients and untreated patients [37]. But it has been shown that antiviral drugs reduce sperm progressive motility, especially when reverse transcriptase nucleoside inhibitors are used [21,22].…”

Detection of HIV and HCV RNA in semen from Brazilian coinfected men using multiplex PCR before and after semen washing

“…In contrast, both recent and earlier studies concluded that purification of motile spermatozoa by either the discontinuous gradient or swim-up method, or even by a combination of these techniques, reduces the number of HIV and/or HCV particles in semen to undetectable levels 8,14,17,18,24,28,32 , making it possible for serodiscordant couples to conceive a child by means of assisted reproduction techniques with minimum risk of seroconversion 14,15,32 .…”

“…This would especially be the case in patients with high HCV titer, due to interference in the production of cellular cytokines, causing the HIV/HCV viral load to increase even further 47 . The advent of HAART, however, is also changing the natural history of HIV/HCV coinfection because of increased patient survival 15 . As a result, an ever increasing number of serodiscordant couples wish to have their own child without resorting to gamete donation in sperm banks or giving up safe sex.…”

“…In their study, HCV RNA was found in 2/39 (5%) of semen and semen fraction samples, giving direct evidence of the risk of contamination that may exist in human reproduction techniques 22 . Other studies concluded that although the presence of HCV in semen is intermittent 31 and not common 13,15 , sexual transmission cannot be ruled out 20,34 .…”