Shah Duru, Harjani Raj, Yadav Vishesha
Department of Reproductive Medicine, Gynaecworld -The Center for Women's Health and Fertility- Mumbai, Maharashtra, India.
Department of Infectious Diseases, Jaslok Hospital and Research Centre - Mumbai, Maharashtra, India.
J Hum Reprod Sci. 2024 Apr-Jun;17(2):94-101. doi: 10.4103/jhrs.jhrs_11_24. Epub 2024 May 28.
Antiretroviral therapy has helped human immunodeficiency virus (HIV)-infected people live an enhanced quality of life and attempt for a pregnancy, without placing their partner at risk. Although periconceptional pre-exposure prophylaxis for the uninfected partner and consistent antiretroviral therapy for the HIV-infected partner are important to prevent HIV transmission, semen washing could be a great option to further reduce the semen viral load.
The aim of this study were as follows: to determine if semen washing with intrauterine insemination provides an added safety net to HIV-serodiscordant couples when the male partner is HIV-infected and virally suppressed and to determine if the U = U concept (undetectable = untransmittable) holds true in virally suppressed HIV-infected males.
This was an observational study conducted in seropositive HIV men under treatment with highly active antiretroviral therapy (HAART) in collaboration with Metropolis Laboratory, a CAP recognised private Healthcare Laboratory in Mumbai, India.
Blood and semen samples were collected from a total of 110 adult HIV-1-infected males virally suppressed on HAART. These samples were processed to assess the viral load in plasma as well as raw and processed semen fractions.
Descriptive statistics were used to analyse the data.
Only men with plasma viral loads < 1000 copies were selected in our study. Out of the 110 HIV-infected individuals, 102 (92.73%) patients had undetectable (<20 copies/ml) plasma viral load while 8 (7.27%) patients had a detectable (>20 copies/ml) viral load, who were excluded from the study. In the virally suppressed 102 men, the raw semen samples of 100 men showed an undetectable viral load, while 2 samples showed detectable contamination, even though their plasma samples from the blood showed a viral load of <20 copies/ml. The semen was then separated into the sperm and the seminal plasma samples. The seminal plasma had <20 copies/ml in 95 samples (93.14%) but a detectable viral load in 7 (6.86%) samples. After subjecting all the 102 processed (post-wash) sperm samples to quantitative analysis, an undetectable viral load of <20 copies/ml was found in all the samples. Thus, the raw sample (prewashed),seminal plasma and processed (postwash) samples were evaluated. The post-wash sperm sample showing zero contamination was frozen for intrauterine insemination (IUI) in the uninfected female partner.
Semen washing with IUI should be advocated as a safe, efficacious way to increase the safety net and to further reduce the minimal risk of HIV transmission in serodiscordant couples in addition to the U = U concept.
抗逆转录病毒疗法帮助人类免疫缺陷病毒（HIV）感染者提高了生活质量，并使其能够尝试怀孕，同时不会让其伴侣面临风险。虽然为未感染的伴侣进行受孕前暴露前预防以及为感染HIV的伴侣持续进行抗逆转录病毒治疗对于预防HIV传播很重要，但精液清洗可能是进一步降低精液病毒载量的一个好选择。
本研究的目的如下：确定当男性伴侣感染HIV且病毒得到抑制时，通过宫内授精进行精液清洗是否能为HIV血清学不一致的夫妇提供额外的安全保障，以及确定“U = U”概念（检测不到 = 不具有传染性）在病毒得到抑制的HIV感染男性中是否成立。
这是一项观察性研究，在印度孟买一家获得美国病理学家协会（CAP）认可的私立医疗实验室——大都会实验室的合作下，对接受高效抗逆转录病毒疗法（HAART）治疗的血清学阳性HIV男性进行。
总共从110名接受HAART治疗且病毒得到抑制的成年HIV - 1感染者中采集血液和精液样本。对这些样本进行处理，以评估血浆以及未处理和处理后的精液部分中的病毒载量。
使用描述性统计分析数据。
我们的研究仅选择血浆病毒载量<1000拷贝的男性。在110名HIV感染者中，102名（92.73%）患者的血浆病毒载量检测不到（<20拷贝/毫升），而8名（7.27%）患者的病毒载量可检测到（>20拷贝/毫升），这些患者被排除在研究之外。在病毒得到抑制的102名男性中，100名男性的未处理精液样本显示病毒载量检测不到，而2个样本显示有可检测到的污染，尽管他们血液中的血浆样本显示病毒载量<20拷贝/毫升。然后将精液分离为精子和精浆样本。95个样本（93.14%）的精浆病毒载量<20拷贝/毫升，但7个样本（6.86%）的病毒载量可检测到。对所有102个处理后（清洗后）的精子样本进行定量分析后，所有样本的病毒载量均检测不到，<20拷贝/毫升。因此，对未处理样本（清洗前）、精浆和处理后（清洗后）样本进行了评估。将显示零污染的清洗后精子样本冷冻，用于未感染女性伴侣的宫内授精（IUI）。
除了“U = U”概念外，应提倡通过宫内授精进行精液清洗，作为一种安全、有效的方法来增加安全保障，并进一步降低血清学不一致夫妇中HIV传播的最小风险。
