Jerónimo A, Baza M B, Río I, Vera M, Hernando V, Castilla J, Rodriguez C, Del Romero J
Centro Sanitario Sandoval, Instituto de Investigación Sanitaria San Carlos (IdISSC), C/Sandoval 7, 28010 Madrid, Spain.
Centro Sanitario Sandoval, Instituto de Investigación Sanitaria San Carlos (IdISSC), C/Sandoval 7, 28010 Madrid, Spain
Hum Reprod. 2017 Feb;32(2):265-271. doi: 10.1093/humrep/dew321. Epub 2016 Dec 21.
How do semen parameters of HIV-infected men under antiretroviral treatment compare with WHO parameters of normal semen, and what factors are associated with any differences?
Semen quality in most HIV-infected patients under antiretroviral treatment exceeds WHO limits, but the number falling below them is higher than would be expected in a healthy population. Exposure to efavirenz has a significant association with dysmotility.
Dysmotility is the most frequently described sperm alteration related to HIV infection, and it has recently been linked to treatment with non-nucleoside reverse transcriptase inhibitors, particularly to efavirenz.
STUDY DESIGN, SIZE, DURATION: Prospective cohort study. Between March 2002 and December 2013, 139 HIV-infected men undergoing antiretroviral therapy were enrolled.
PARTICIPANTS/MATERIALS, SETTING, METHODS: Participants were male members of serodiscordant couples who attended a clinic for sexually transmitted infections (STIs) in Madrid and requested reproductive counselling. Sociodemographic, behavioural and clinical data were collected. CD4 lymphocyte count, HIV viral load, serology/viral load of hepatitis B and C viruses, syphilis serology and other STIs diagnosis were performed. Semen parameters were assessed through standard sperm analysis and were compared with WHO 2010 reference values. Factors associated with impaired semen parameters were evaluated by bivariate and multivariate analysis.
The median values of all assessed semen parameters were within a normal range, but in up to 19% of HIV-positive males, at least one parameter of semen quality was below the normal range. A significant association between treatment with efavirenz and the presence of dysmotility was detected in the multivariate analysis.
LIMITATIONS, REASONS FOR CAUTION: Our results cannot demonstrate a causal relationship between exposure to efavirenz and impaired motility. We do not have a real comparison group as the WHO cohort is international and may not reflect local variations in semen characteristics. Subjects who requested reproductive counselling might not be representative of HIV-positive men in general.
Since efavirenz is still widely used in current therapeutic regimens may be affecting fertility in seropositive men who desire procreation.
STUDY FUNDING/COMPETING INTERESTS: No external funding was used for this study. The authors have no conflict of interest to declare.
接受抗逆转录病毒治疗的HIV感染男性的精液参数与世界卫生组织正常精液参数相比如何，哪些因素与这些差异相关？
大多数接受抗逆转录病毒治疗的HIV感染患者的精液质量超过世界卫生组织的标准，但低于标准的人数高于健康人群的预期。接触依非韦伦与精子活力不足有显著关联。
精子活力不足是与HIV感染相关的最常描述的精子改变，最近它与非核苷类逆转录酶抑制剂治疗有关，特别是与依非韦伦有关。
研究设计、规模、持续时间：前瞻性队列研究。2002年3月至2013年12月期间，招募了139名接受抗逆转录病毒治疗的HIV感染男性。
参与者/材料、设置、方法：参与者是血清学不一致夫妇中的男性成员，他们前往马德里一家性传播感染诊所并寻求生殖咨询。收集了社会人口统计学、行为和临床数据。进行了CD4淋巴细胞计数、HIV病毒载量、乙型和丙型肝炎病毒的血清学/病毒载量、梅毒血清学及其他性传播感染诊断。通过标准精子分析评估精液参数，并与世界卫生组织2010年参考值进行比较。通过双变量和多变量分析评估与精液参数受损相关的因素。
所有评估的精液参数中位数均在正常范围内，但高达19%的HIV阳性男性至少有一项精液质量参数低于正常范围。多变量分析检测到依非韦伦治疗与精子活力不足之间存在显著关联。
局限性、谨慎原因：我们的结果无法证明接触依非韦伦与活力受损之间存在因果关系。我们没有真正的对照组，因为世界卫生组织队列是国际性的，可能无法反映精液特征的局部差异。寻求生殖咨询的受试者可能不代表一般的HIV阳性男性。
由于依非韦伦仍广泛用于当前治疗方案，可能会影响有生育意愿的血清阳性男性的生育能力。
研究资金/利益冲突：本研究未使用外部资金。作者声明无利益冲突。
