AIDS男性可預防性化療chemoprophylaxis再施行AIH

HIV男性施行人工授精最有效之預防方法為清洗精蟲sperm washing(grading, swim-up, wash)
另一方法為預防性化學藥劑治療pre-exposure chemoprophylaxis (PrEP)降低HIV titler

http://humupd.oxfordjournals.org/content/19/2/136.abstract

Reproductive assistance in HIV serodiscordant couples

1. V. Savasi1,*, 
2. L. Mandia1, 
3. A. Laoreti1 and 
4. I. Cetin1,2

+Author Affiliations

1. ¹Unit of Obstetrics and Gynecology, Department of Clinical Sciences, Hospital ‘L. Sacco’, University of Milan, Via G. B. Grassi, 74, 20157 Milan, Italy
2. ²Centre for Fetal Research Giorgio Pardi, University of Milan, Milan, Italy

1. ↵*Correspondence address. E-mail: valeria.savasi@unimi.it

• Received February 8, 2012.
• Revision received September 26, 2012.
• Accepted October 5, 2012.

Abstract

BACKGROUND Three quarters of individuals infected with human immunodeficiency virus (HIV) are in their reproductive years and may consider pregnancy planning. Techniques have been developed which can minimize the risk of HIV transmission in these couples, and the current literature on this topic is reviewed here.

METHODS We reviewed the literature for the following topics: risk of HIV transmission, effects of HIV infection on fertility, reproductive assistance in industrialized and low-income countries, pre-exposure chemoprophylaxis (PrEP) and timed intercourse in HIV-discordant couples for both male and female positivity. Relevant publications were identified through searches of the EMBASE Medline and PubMed databases, the Google-indexed scientific literature and periodic specialized magazines from the on-line Library Service of the University of Milan, Italy.

RESULTS In serodiscordant couples in which the man is positive, the primary method used to prevent HIV transmission is ‘sperm washing’, followed by IUI or IVF. Data show that sperm washing in HIV-positive men has not produced seroconversion in women or their offspring; however, the evidence is limited. Recently, increasing evidence describing PrEP for HIV prevention has been published and PrEP could be an alternative to ART for fertile couples. Usually HIV-infected women undergo self-insemination around the time of ovulation. Few studies have been published on IVF outcome in HIV-infected women.

CONCLUSIONS Assisted reproduction programmes should be integrated into global public health services against HIV. For HIV serodiscordant couples with infected men, sperm washing should be the first choice. However, timed intercourse and PrEP for HIV prevention has been reported. Recent data highlight the possible impairment of fertility in HIV-infected women. Efforts to design a multicentric study should be strengthened.