Gilling-Smith C
Chelsea & Westminster Hospital, London.
AIDS Read. 2000 Oct;10(10):581-7.
Serodiscordant couples in whom the man is HIV-1-positive and the woman is negative have limited options if they wish to have children safely, because sexual intercourse carries a 1-in-500 risk of transmitting virus in semen to the female partner. Sperm washing is a risk-reduction option in which infected sperm are washed free of virus before insemination into the female partner at the time of ovulation. Absence of detectable HIV is verified before insemination using a polymerase chain reaction nucleic acid-based sequence amplification assay. Pregnancy rate per insemination is 14%, based on a European experience of more than 2000 inseminations; to date, there have been no seroconversions in either mother or child. Washed sperm have also been used in other assisted conception treatments, such as in vitro fertilization. In the United States, the CDC has recommended against insemination of women with semen from men infected with HIV. Current data from programs in Europe would suggest sperm washing to be a safe risk-reduction option for heterosexual couples wishing to bear a child. We suggest that sperm washing should only be carried out in dedicated units using a multidisciplinary approach to ensure that couples receive adequate preconceptual counseling, detailed sexual health and fertility assessment, and careful monitoring of the woman's HIV status during treatment and pregnancy.
对于男性为HIV-1阳性而女性为阴性的血清学不一致的夫妇而言，如果他们希望安全地生育孩子，选择会很有限，因为性交时精液将病毒传播给女性伴侣的风险为五百分之一。精子清洗是一种降低风险的选择，即在排卵时将感染病毒的精子清洗干净后再授精给女性伴侣。授精前使用基于聚合酶链反应核酸序列扩增检测法来验证是否检测不到HIV。根据欧洲超过2000次授精的经验，每次授精的妊娠率为14%；迄今为止，母亲或孩子均未出现血清转化。清洗后的精子也已用于其他辅助受孕治疗，如体外受精。在美国，疾病控制与预防中心已建议不要用感染HIV的男性的精液对女性进行授精。欧洲项目的当前数据表明，对于希望生育孩子的异性恋夫妇来说，精子清洗是一种安全的降低风险的选择。我们建议，精子清洗应仅在专门的机构中采用多学科方法进行，以确保夫妇接受充分的孕前咨询、详细的性健康和生育能力评估，并在治疗和怀孕期间仔细监测女性的HIV状况。
