Sperm washing to prevent HIV transmission from HIV-infected men but allowing conception in sero-discordant couples

Sperm washing is a technique that concentrates and separates the seminal fluid from the sperm in HIV-positive males. HIV is known to reside in the semen of HIV-positive men. When a woman wants to get pregnant, she is artificially inseminated with the sperm after it is washed and becomes virus-free. Sperm washing is done with the help of a centrifuge. The centrifuge is a device that spins at a high speed to separate the sperm from the seminal fluid in a given sample of semen. The sperm is then purified in a solution twice, in order to clean other unwanted substances in it, including the HIV. This technique was first introduced in 1992 in Milan, Italy by Augusto Enrico Semprini and colleagues, with the aim of helping HIV positive couples to conceive a healthy baby and to ensure that females do not acquire the disease from an HIV-positive male. Nowadays, many couples opt for sperm washing because it prevents the female partner from getting infected with HIV and enables the HIV positive male to propagate a healthy family. However, this process can be very lengthy and expensive. It is very helpful if both partners understand sperm washing to be a risk-reduction method and not a risk-free method as, technically, the virus could still be present in the washed sample at a titer below the detection limit of the HIV assay. There have been no reports of seroconversion in the female partner when semen has been correctly processed. Hence, the risks of not performing sperm washing need to be strongly discussed with sero-discordant couples.

Authors' conclusions: 

Reports on the use of sperm washing to prevent HIV transmission, from HIV-infected men but allowing conception in sero-discordant couples, are currently limited to observational studies. No randomised controlled trial has assessed the benefit or risk of sperm washing to prevent HIV transmission from HIV-infected men but allow conception in sero-discordant couples. Thus, this systematic review identifies the need for a multicentre randomised controlled trial assessing the benefits and possible risks of sperm washing in preventing HIV transmission from HIV-infected men but allow conception in sero-discordant couples.

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Background: 

Sperm washing is a term used to describe the process in which individual spermatozoa are separated from the seminal fluid. Sperm washing is used to prevent HIV transmission but allow conception in sero-discordant couples, where the male is HIV positive, but the female is HIV negative. This procedure is based on the observation that HIV cannot attach itself to spermatozoa, but it can be found in the fluid and cells surrounding spermatozoa.

Objectives: 

To determine the benefits and harms of sperm washing of HIV-infected males when used to prevent the transmission of HIV but allowing conception in the HIV-negative female.

Search strategy: 

We searched the Cochrane HIV/AIDS Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, SCOPUS, AIDsearch, AJOL, LILACS and INDEX MEDICUS. We also searched the following conference proceedings for relevant abstracts:The International AIDS Conference; The Conference on Retroviruses and Opportunistic Infections (CROI); The British HIV Association (BHIVA) Conference; The International Conference of Obstetricians and Gynecologists (FIGO); The American Academy of HIV Medicine Conference; The Australasian HIV/AIDS Conference; The American Society for Reproductive Medicine (ASRM) conferences and website; The European Society for Human Reproduction and Embryology (ESHRE) conferences and websites, and the British Fertility Society (BFS) conferences and website. We also conducted a search of the website: www.ClinicalTrials.gov. The date of the most recent Cochrane HIV/AIDS Group Controlled Trials Register search was on the 10th of November, 2010.

Selection criteria: 

We preferentially looked for randomised or quasi-randomised controlled trials on sperm washing, aimed at preventing HIV transmission from HIV-infected men but allowing conception in sero-discordant couples, irrespective of publication status, year of publication, or language in the review.

Data collection and analysis: 

No relevant trials were identified for inclusion in this review.

Main results: 

Forty-four studies were identified, but none of them were suitable for inclusion in this review.

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