Royal Women's Hospital, Melbourne, VIC, Australia.
Med J Aust. 2011 Nov 21;195(10):599-601. doi: 10.5694/mja11.10156.
To describe the clinical outcomes for all HIV-serodiscordant couples attending an assisted reproduction program.
DESIGN, SETTING AND PARTICIPANTS: Retrospective review of demographic, clinical and outcome data for all HIV-serodiscordant couples who attended an assisted reproduction program at a tertiary hospital in Melbourne, between its commencement in 2003 and June 2010.
Pregnancies, miscarriages, births, HIV transmission to the HIV-negative partner, semen quality and detection of HIV (HIV RNA and HIV DNA) in semen.
As of June 2010, 39 HIV-positive clients had proceeded to assisted reproduction after the initial consultation in the program. There were 162 completed cycles, with 26 pregnancies (clinical pregnancy rate per cycle, 16.2% for HIV-positive men with an HIV-negative partner, and 15.4% for HIV-positive women). Of all 222 tested semen samples, 18 (8%) had HIV RNA detected despite these men receiving antiretroviral therapy and having an undetectable HIV viral load in plasma. Sperm velocity was significantly lower in HIV-positive clients receiving combination antiretroviral therapy than in a control group of recipient-recruited sperm donors (P = 0.01); there were no other significant differences in sperm quality between the two groups. No HIV transmission to babies or HIV-negative partners occurred.
Our findings show detectable HIV in 8% of semen samples from men with an undetectable HIV viral load in plasma, but confirm the safety of assisted reproduction for HIV-serodiscordant couples within a program with strict protocols for HIV treatment and testing of all semen before use.
描述所有接受辅助生殖项目的 HIV 血清不一致夫妇的临床结局。
设计、地点和参与者：对所有在墨尔本一家三级医院接受辅助生殖项目的 HIV 血清不一致夫妇的人口统计学、临床和结局数据进行回顾性分析，该项目始于 2003 年，至 2010 年 6 月结束。
妊娠、流产、分娩、HIV 阴性伴侣的 HIV 传播、精液质量和精液中 HIV（HIV RNA 和 HIV DNA）的检测。
截至 2010 年 6 月，在该项目的初始咨询后，39 名 HIV 阳性患者接受了辅助生殖。共完成 162 个周期，26 例妊娠（HIV 阳性男性与 HIV 阴性伴侣的临床妊娠率为每周期 16.2%，HIV 阳性女性为 15.4%）。在所有 222 个测试的精液样本中，尽管这些男性接受了抗逆转录病毒治疗且血浆中 HIV 病毒载量无法检测到，但仍有 18 个（8%）样本检测到 HIV RNA。接受联合抗逆转录病毒治疗的 HIV 阳性患者的精子速度明显低于接受受体招募的精子供体的对照组（P = 0.01）；两组之间的精子质量没有其他显著差异。未发生 HIV 向婴儿或 HIV 阴性伴侣的传播。
我们的研究结果显示，在血浆中 HIV 病毒载量无法检测到的男性中，有 8%的精液样本中可检测到 HIV，但证实了在严格遵守 HIV 治疗方案和所有精液使用前进行检测的项目中，辅助生殖对 HIV 血清不一致夫妇是安全的。
