Sperm washing and virus nucleic acid detection to reduce HIV and hepatitisC virus transmission in serodiscordant couples wishing to have children

Background: Use of a motile spermatozoa isolation process was assessed for reducing the transmission of HIV and hepatitis C virus (HCV) during artific ial insemination in HIV-serodiscordant couples in which the man is infected . Patients: Thirty-two HIV-l-infected clinically asymptomatic men, having a m edian CD4 cell count of 396 x 10(6)/1 and a median blood plasma HIV-1 RNA c ontent of 414 copies/ml. Of these, 16 were infected with both HIV and HCV. Methods: Motile spermatozoa were isolated from 51 semen samples by density gradient and 'swim-up'. HIV-1 and HCV genomes were detected and quantified in the blood plasma and seminal plasma, and detected in seminal cell fracti ons obtained during spermatozoa isolation. Results: HIV-1 RNA was detected in 30% of seminal plasma samples. HIV-1 gen omes were found in 18% of seminal cell samples, but in none of the motile s permatozoa fractions after 'swim-up'. There was no correlation between the HIV-1 RNA concentrations in the blood and seminal plasma. HIV-1 genome was detected intermittently in patients who gave more than one sample. HCV RNA was detected in 20% of seminal plasma samples from HCV viraemic patients, b ut in no seminal cells or motile spermatozoa fractions. Conclusions: Purification of motile spermatozoa by density gradient plus 's wim-up' reduced the HIV-1 and HCV genomes in the semen of infected individu als to undetectable levels. This method, associated with a standardized vir us assay, could be useful for serodiscordant couples (males infected) who w ish to have children. (C) 2000 Lippincott Williams & Wilkins.