Paternal HIV infection and transfer of HIV from mother to fetus

Chronic testicular Chlamydia muridarum infection impairs mouse fertility and offspring development†

With approximately 131 million new genital tract infections occurring each year, Chlamydia is the most common sexually transmitted bacterial pathogen worldwide. Male and female infections occur at similar rates and both cause serious pathological sequelae. Despite this, the impact of chlamydial infection on male fertility has long been debated, and the effects of paternal chlamydial infection on offspring development are unknown. Using a male mouse chronic infection model, we show that chlamydial infection persists in the testes, adversely affecting the testicular environment. Infection increased leukocyte infiltration, disrupted the blood:testis barrier and reduced spermiogenic cell numbers and seminiferous tubule volume. Sperm from infected mice had decreased motility, increased abnormal morphology, decreased zona-binding capacity, and increased DNA damage. Serum anti-sperm antibodies were also increased. When both acutely and chronically infected male mice were bred with healthy female mice, 16.7% of pups displayed developmental abnormalities. Female offspring of chronically infected sires had smaller reproductive tracts than offspring of noninfected sires. The male pups of infected sires displayed delayed testicular development, with abnormalities in sperm vitality, motility, and sperm-oocyte binding evident at sexual maturity. These data suggest that chronic testicular Chlamydia infection can contribute to male infertility, which may have an intergenerational impact on sperm quality.

Fertility options for HIV patients

PURPOSE OF REVIEW

This paper reviews the latest reproductive options for HIV infected couples. In light of the new treatment options and improved prognosis for HIV patients, policymakers have issued recent statements to guide physicians in the care of HIV patients desiring fertility. We will review the advances in reproductive technologies and ethical considerations that have led to these most recent statements.

RECENT FINDINGS

Millions of young adults of reproductive age are afflicted with the HIV virus. With the improvement in treatment options for HIV patients and the increase in their life expectancy it is not surprising that many HIV patients desire children. Assisted reproductive technologies can assist serodiscordant couples in achieving pregnancy while at the same time minimizing risk of HIV transmission to the uninfected partner. Several European fertility clinics have a great deal of experience in providing both intrauterine inseminations and in-vitro fertilization to serodiscordant couples without seroconversion of the uninfected female partners. This is both a medical and an ethical issue. Guidelines from policymakers regarding this issue have changed over the years as a result of both changes in disease prognosis and the reproductive technologies.

SUMMARY

Reproductive technologies provide a logical way to minimize HIV transmission for HIV couples desiring pregnancy. Although the most recent research is compelling, much more needs to be performed in order to establish the safety of these techniques. Protocols need to be put in place in order to assist physicians in better serving these patients. In addition, many ethical and legal issues need to be addressed before these treatments can become standard of care in the United States.

The antiviral agents, MAP30 and GAP31, are not toxic to human spermatozoa and may be useful in preventing the sexual transmission of human immunodeficiency virus type 1

OBJECTIVE

To investigate the effects of two virucidal compounds, MAP30 (Momordica anti-human immunodeficiency virus [HIV] protein; molecular weight, 30 kd) and GAP31 (Gelonium anti-HIV protein; molecular weight, 31 kd), obtained from Momordica charantia and Gelonium multiflorum, respectively, on the motility and vitality of human spermatocytes.

DESIGN

Prospective, controlled study.

SETTING

New York University School of Medicine.

PATIENT(S)

Ten healthy men undergoing evaluation for infertility provided 10 semen specimens.

INTERVENTION(S)

Human sperm were treated with the anti-HIV agents, MAP30 and GAP3 1. Nonoxynol-9, a commonly used spermicide, and phosphate-buffered saline were used as the positive and negative controls, respectively.

MAIN OUTCOME MEASURE(S)

The motility and vitality of human spermatocytes treated with MAP30 and GAP31 at doses that inhibit HIV-1 and herpes simplex virus.

RESULT(S)

MAP30 and GAP31 did not inhibit the motility or vitality of human sperm cells over a dose range of 100-0.1 microg/mL, whereas nonoxynol-9 demonstrated spermicidal action on all 10 samples over the same dose range.

CONCLUSION(S)

The antiviral agents, MAP30 and GAP31, were not toxic to human sperm cells at the doses at which they inhibit HIV-1 and herpes simplex virus. They had no effect on the motility of spermatozoa, even at a dose of 1,000 times the maximum effective concentration. These results indicate that MAP30 and GAP31 may be useful as nonspermicidal protection against sexually transmitted diseases.

Human immunodeficiency virus type 1--serodiscordant couples can bear healthy children after undergoing intrauterine insemination

OBJECTIVE

To use semen from men who were seropositive for human immunodeficiency virus type 1 (HIV-1) to inseminate their partners without infecting them.

DESIGN

Prospective study.

SETTING

Private practice.

PATIENT(S)

Sixty-three HIV-1-seropositive men and their HIV-1-seronegative female partners.

INTERVENTION(S)

The men provided 107 semen samples that were prepared with the use of the Percoll and swim-up techniques. The presence of HIV-1 was determined in the fraction of motile spermatozoa obtained after washing. If HIV-1 was not detected. IUI was performed in stimulated cycles.

MAIN OUTCOME MEASURE(S)

Human immunodeficiency virus type 1 RNA and DNA were detected with the use of the polymerase chain reaction technique modified for spermatozoa.

RESULT(S)

One hundred seven semen samples were washed. Human immunodeficiency virus type 1 was not detected in 101 samples (94.4%) and was detected in 6 samples (5.6%). In the latter cases, IUI was not performed. One hundred one IUI procedures were performed in 63 women. Thirty-one pregnancies resulted, for a pregnancy rate of 30.7% per cycle and 49.2% per inseminated woman. Thirty-seven healthy children were born. The results of tests for the detection of HIV-1 and antibodies to HIV-1 in the inseminated women were negative.

CONCLUSION(S)

On the basis of these results, testing for HIV-1 with the use of the polymerase chain reaction technique on the semen fraction obtained after washing appears to prevent infection in the inseminated woman. This method makes it possible to help HIV-1-seropositive men to have children without infecting their female partners.