Reports on HIV/AIDS: 1990

APRIL 20, 1990, MMWR, Vol. 39, No. 15, pp. 249, 255-256
HIV-1 Infection and Artificial Insemination with Processed Semen
In January 1990, a health department in the United States received a report of
human immunodeficiency virus type 1 (HIV-1) infection in a woman who had been
artificially inseminated with semen from her HIV-1-infected, hemophilic husband.
The man had tested positive for HIV-1 antibody in 1985, but his wife had been
negative for HIV-1 antibody yearly since 1985, most recently in December 1988. In
August, October, and December 1989, the woman was inseminated with semen from
her husband.
In each of the inseminations, fresh ejaculate was processed in an attempt to
remove virus from spermatozoa to avoid HIV-1 transmission. In August, the semen
was centrifuged to separate cells from seminal plasma. The cellular pellet was
washed and recentrifuged twice in a HEPES* buffer and introduced into the woman's
uterus through a catheter placed in her cervix. In October and December, fresh
ejaculate was fractionated by centrifugation through a discontinuous density gradient
of polyvinylpyrrolidone-coated silica particles (Percoll~t) to separate motile spermatozoa from other cells and seminal plasma. The fraction containing motile spermatozoa was washed twice in buffer and introduced into the woman's uterus through a
catheter. After each procedure, the woman developed mild cramping but no
bleeding; she did not become pregnant. However, in January 1990, she tested
positive for HIV-1 antibody by enzyme immunoassay (EIA) and Western blot.
The couple reported using latex condoms with each episode of vaginal intercourse
(two to four times monthly) since 1986, denied any instances of condom breakage,
and did not engage in oral or anal intercourse. The woman denied skin contact with
her husband's blood or with any of the needles he used to inject himself with factor
VIII concentrate. She had had no other sex partners since 1985 and had not used
drugs intravenously, received blood or blood products, or worked in a health-care
setting. She reported no viral illnesses between July 1988 and August 1989. In
September 1989, 3 weeks after the first insemination, she was ill for 3 days with a sore
throat, tinnitus, nausea, and vomiting. During late November, between the second
and third inseminations, she noticed a nontender cervical lymph node. In December,
3 weeks after the third insemination, she developed a low-grade fever, abdominal
cramps, and watery diarrhea that lasted 4-5 days.
The physician who performed the inseminations reported that in January 1990 a
second HIV-1-discordant couple (i.e., seropositive husband with hemophilia, seronegative wife) underwent one insemination using the same density gradient centrifugation procedure. Nine weeks after the insemination, the woman was negative for
HIV-1 antibody by EIA and Western blot and for proviral HIV-1 DNA by polymerase
chain reaction.
To investigate the methods used to prepare semen from these men for insemination, semen from five HIV-infected men with hemophilia was processed in the same
*4-(2-Hydroxyethyl)piperazineethanesulfonic acid.
tUse of trade names is for identification only and does not imply endorsement by the Public
Health Service or the U.S. Department of Health and Human Services.

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