Safe conception for HIV-discordant couples: insemination with processed semen from the HIV-infected partner

• Published in: American journal of obstetrics and gynecology Vol. 208; no. 5; pp. 402.e1 - 402.e9
• Main Authors: Semprini, Augusto Enrico, MD, Macaluso, Maurizio, MD, DPH, Hollander, Lital, MSc, Vucetich, Alessandra, MD, Duerr, Ann, MD, PhD, Mor, Gil, MD, PhD, Ravizza, Marina, MD, Jamieson, Denise J., MD, MPH
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01-05-2013
• Subjects: Adult; assisted reproduction; effectivenes; Female; Follow-Up Studies; HIV Infections - prevention & control; HIV Infections - transmission; human immunodeficiency virus transmission; Humans; Insemination, Artificial, Homologous - methods; Live Birth; Logistic Models; Male; Obstetrics and Gynecology; Odds Ratio; Patient Safety; Pregnancy - statistics & numerical data; Pregnancy, Multiple - statistics & numerical data; Retrospective Studies; safety; Treatment Outcome; assisted reproduction; follow-up studies; human immunodeficiency virus transmission; safety; effectivenes
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2013.02.009

Objective The objective of the study was to evaluate the safety of semen washing with intrauterine insemination (SW-IUI) for achieving pregnancy when the man is human immunodeficiency virus (HIV) infected and the woman is HIV negative. Study Design We conducted a retrospective analysis of 635 HIV-discordant couples enrolled in a SW-IUI program and followed up 367 Italian women. We computed pregnancy, live birth, and multiple delivery rates and assessed the women's postinsemination HIV status. Results The retrospective analysis included 635 couples (2113 SW-IUI cycles): 41% of the women (95% confidence interval [CI], 37–45%) had a live birth (per-cycle live birth rate 13%; 95% CI, 11–14%). HIV status after SW-IUI was negative when available but unknown for 26% of the women: missing HIV status was not associated with correlates of HIV risk. The follow-up study included 367 couples (1365 cycles): 47% of the women (95% CI, 42–52%) had a live birth (per-cycle rate 14%; 95% CI, 12–16%). Ascertainment of postinsemination HIV status was complete and confirmed no HIV transmission attributable to SW-IUI. The upper 95% confidence limit of the HIV transmission rate was 1.8 per 1000 cycles in the retrospective analysis and 2.7 per 1000 cycles in the follow-up study. Conclusion SW-IUI appears to be a safe and effective method for achieving pregnancy in HIV-discordant couples in which the man is HIV infected.