Allahbadia Gautam N
Rotunda-The Center For Human Reproduction, Mumbai, India.
J Obstet Gynaecol India. 2016 Jun;66(3):139-43. doi: 10.1007/s13224-015-0802-x. Epub 2015 Nov 13.
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.
艾滋病毒血清学不一致的夫妇积极寻求生殖援助,并且常常考虑或采取不安全措施来实现怀孕。在治疗之前,需要解决这些夫妇特有的生殖问题和担忧。辅助生殖技术可以将与血清学不一致夫妇相关的感染风险和组建家庭的风险降至最低。自1987年以来,已有超过4000例公开报道的尝试,其中使用来自艾滋病毒血清阳性男性的处理过的精子使艾滋病毒血清阴性女性怀孕。当女性伴侣为艾滋病毒阳性时,宫内授精(IUI)就足以预防水平感染。然而,当男性伴侣为艾滋病毒阳性时,为了将健康伴侣的感染风险降至最低,会采用15年前在米兰研发的一项涉及精子清洗的技术。由于存在先天性不孕问题,一些夫妇需要借助先进的生殖技术(ART)程序,如体外受精(IVF)或卵胞浆内单精子注射(ICSI)进行进一步治疗。近期采用抗逆转录病毒药物进行暴露前预防(PrEP)等创新方法可能会进一步降低未感染女性伴侣的易感性。全球众多ART中心为这些夫妇提供治疗。大多数中心都设有单独的实验室空间,用于采集感染患者的标本,并提供单独的储存罐来冷冻感染的配子和胚胎,以保护使用该设施的其他患者。目前尚无报告表明按照现行实验室规程处理血清学不一致夫妇的配子/胚胎会导致实验室人员感染艾滋病毒。同一实验室中其他夫妇的配子或胚胎也未出现交叉污染的报告。这种风险仅存在于理论上,尤其是在采用标准的通用预防措施时。