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Introduction to HIV Discordant Couple Insemination

Introduction to HIV Discordant Couple Insemination. Deborah J. Anderson, Ph.D. Dept Medicine and Center for AIDS Research Harvard Medical School and Department of Obstetrics & Gynecology Boston University School of Medicine Boston, MA. 1987.

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Introduction to HIV Discordant Couple Insemination

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  1. Introduction to HIV Discordant Couple Insemination Deborah J. Anderson, Ph.D. Dept Medicine and Center for AIDS Research Harvard Medical School and Department of Obstetrics & Gynecology Boston University School of Medicine Boston, MA

  2. 1987 • HIV/AIDS: a poorly understood lethal sexually transmitted disease • Stewart et. (1985): seroconversion in 4 women following AI with semen from an HIV+ donor • Published reports of HIV attachment to sperm • High fetal maternal transmission rate

  3. Dr. Enrico Semprini proposed to establish a protocol to reduce the risk of HIV transmission in HIV-1 discordant couples desiring a child

  4. Gradient Sperm Separation Method HIV p24 Discontinuous Density Gradient ++++ Seminal Plasma ++ 47% Separation Medium Nonmotile Sperm, Immature Germ Cells WBCs ++ 90% Separation Medium +/- Motile Sperm

  5. Swim-up Method Swim-up HIV p24 Motile Sperm for Insemination +/- Swim-up Sperm Wash ++ Medium

  6. Gradient/Swim-up Method HIV p24 Seminal Plasma 47% Separation Medium Nonmotile Sperm, Immature Germ Cells WBCs undetectable 90% Separation Medium Swim-up Wash Pellet Motile Sperm

  7. Additional elements in Semprini protocol: Reduce exposure by maximizing fertility and optimal timing of fertilization Reduce transmission risk by treating STDs and reducing HIV viral load

  8. 1990 Chiasson MA, Stoneburner RL, et al. Human Immunodeficiency Type 1 virus transmission through artificial insemination. JAIDS 3:69-72, 1990 131 women in New York inseminated with fresh semen from 6 HIV+ donors. One seroconverted.

  9. 1990 Centers for Disease Control. HIV-1 infection and artificial insemination with processed sperm. MMWR 39: 249-56, 1990. Recommendation: Do not used processed semen from HIV+ donors for artificial insemination

  10. 1992 Semprini AE, Levi-Setti P, Bozzo M, Ravizza M, Pardi G. Insemination of HIV-negative women with processed semen of HIV-positive partners. Lancet 340:1317-9, 1992.

  11. 1993 American Society for Reproductive Medicine Guidelines: ART services should be withheld from HIV-infected individuals or couples. Fertility and Sterility 59 (Suppl 1): 1-39, 1993.

  12. 1997 Mandelbrot L, Heard I, et al. Natural conception in HIV-negative women with HIV infected partners. Lancet 349:850-1; 1997. 5% seroconversion rate in 92 HIV-discordant couples that practiced unprotected intercourse to conceive a child.

  13. 1998 Marina S, et al. Human immunodeficiency virus type-1 serodiscordant couples can bear healthy children after undergoing intrauterine insemination . Fertil. Steril. 70: 35-39, 1998.

  14. 2000 • CreaThe is established: a consortium of 11 clinics in Europe that provide assisted reproductive technology services to HIV-1 infected couples. • Forum for discussion • Guidelines and protocols • European database

  15. 2002 Antiretroviral therapy has changed the perception of HIV-1 disease (chronic but manageable) and reduced the maternal-fetal transmission rate to <5%. HIV-1 infected individuals protected against medical discrimination by the Americans with disability act.

  16. 2002 Recommendations of the ASRM Ethics Committee on Human Immunodeficiency Virus and Infertility Treatment. Fertility and Sterility 77: 218-222, 2002. Fertility services cannot be reasonably withheld from individuals with chronic viral infections including HIV-1.

  17. US Experience Sauer MV. Providing fertility care to those with HIV: time to re-examine healthcare policy. AJOB 2003; 3: 3-40. ICSI procedure for insemination with HIV+ sperm

  18. Resource Poor Settings • Should timed inseminations be recommended for HIV discordant couples that want to have children? • Fertility work-up • Treatment of STIs • Under development: sperm-friendly vaginal microbicides.

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