Obstetrics, Gynecology and Women's Health, University of Missouri School of Medicine, Columbia, MO, USA.
Department of Urology, University of Kansas Medical Center, Kansas City, KS, USA.
Adv Exp Med Biol. 2017;1034:163-178. doi: 10.1007/978-3-319-69535-8_11.
The use of antiviral medications has increased with the recognition and treatment of HIV infections, and these drugs are the main focus of this chapter. HIV has become a chronic disease, and many men with HIV desire children. The disease itself has profound negative effects on semen quality, as does infection with hepatitis C virus (HCV), so treatment with antivirals generally improves semen quality in men with longer duration of infection and/or greater symptoms. Several changes in medical practice have allowed studies of pharmacopathology of antiviral medications and brought focus on medication effects in asymptomatic men: (1) the successful practice of specialized sperm washing of asymptomatic men with HIV infection for insemination of their HIV-negative partner; (2) the recommendation that men begin anti-retroviral treatment before HIV symptoms appear; and (3) the recommendation that men without HIV infection who have HIV-seropositive partners take HIV prophylaxis. Early cases of HIV infection were generally treated by monotherapy with the nucleoside analog reverse transcriptase inhibitor (NRTI) zidovudine (AZT). Currently, men with HIV infections take combination anti-retroviral therapy (cART), involving three or more medications, making it difficult to assess the toxicity of individual medications. In general, zidovudine alone or cART have minimal negative effects on semen quality; the most common being decreased rapid swimming of motile sperm. We review studies with other outcomes and animal studies in this chapter. Peginterferon-α, which is utilized together with ribavirin to treat HCV, does appear to decrease testosterone levels and semen quality although studies showing these effects have been small. Antiviral medications used to treat viral infections other than HIV and HCV have received little experimental attention for male reproductive effects, even in experimental species.
随着对 HIV 感染的认识和治疗的增加，抗病毒药物的使用也有所增加，这些药物是本章的主要重点。HIV 已成为一种慢性病，许多感染 HIV 的男性希望生育子女。该疾病本身对精液质量有深远的负面影响，丙型肝炎病毒（HCV）感染也是如此，因此，抗病毒治疗通常可以改善感染时间较长和/或症状较重的男性的精液质量。医学实践中的一些变化使人们能够研究抗病毒药物的药物病理学，并关注无症状男性的药物作用：（1）成功实践了对无症状 HIV 感染男性进行专门的精子洗涤，以对其 HIV 阴性伴侣进行授精；（2）建议男性在出现 HIV 症状之前开始抗逆转录病毒治疗；（3）建议 HIV 阴性、HIV 阳性伴侣的男性服用 HIV 预防药物。早期的 HIV 感染通常采用单一疗法，使用核苷类似物逆转录酶抑制剂（NRTI）齐多夫定（AZT）进行治疗。目前，HIV 感染者采用联合抗逆转录病毒治疗（cART），涉及三种或更多药物，这使得评估单个药物的毒性变得困难。一般来说，单独使用齐多夫定或 cART 对精液质量的负面影响极小；最常见的是精子快速游动的比例降低。我们在本章中综述了具有其他结果的研究和动物研究。聚乙二醇干扰素-α与利巴韦林联合用于治疗 HCV，似乎确实会降低睾酮水平和精液质量，尽管显示这些效果的研究规模较小。用于治疗 HIV 和 HCV 以外的病毒感染的抗病毒药物，即使在实验物种中，对男性生殖影响的实验研究也很少。
