Reports on HIV/AIDS: 1990

APRIL 20, 1990, MMWR, Vol. 39, No. 15, pp. 249, 255-256
laboratory using both procedures reported here. In four of the five semen samples,
leukocytes were present before processing. Leukocytes remained in all four samples
after simple centrifugation and washing and in two of three samples tested after
density gradient centrifugation. In two, CD4+ lymphocytes were present after simple
centrifugation and washing.
To assess the interest in insemination among HIV-discordant couples and the
frequency of such procedures, 40 of the 222 hemophilia treatment centers in the
United States were surveyed by telephone. Twenty-six (65%) centers reported
receiving inquiries from HIV-discordant couples interested in such procedures, and 13
(33%) had referred interested couples to specialists for information or insemination;
one reported a couple who had conceived without HIV-1 transmission after insemination with processed semen. In general, respondents reported that couples who
sought such information were well-informed about HIV infection but were highly
motivated to conceive their own children.
Reported by: Epidemiology Br, Div of HIV/AIDS and Epidemiology Activity, Div of Immunologic,
Oncologic, and Hematologic Diseases, Center for Infectious Diseases; Div of Field Svcs,
Epidemiology Program Office, CDC.
Editorial Note: The mode of HIV-1 transmission to the woman described in this
report cannot be determined definitively. Although she reported symptoms suggestive of an acute retroviral syndrome, no single episode is specific enough to establish
the time of infection. The possibility of sexual transmission from her husband cannot
be excluded. However, the insemination procedures may have resulted in transmission; infected leukocytes or free virus may not have been removed from the
husband's semen with the procedures used.
There is no evidence that any procedure can reliably eliminate HIV from semen.
HIV-1 has been isolated from the leukocyte fraction and from seminal plasma from
HIV-1-infected men (1-3). Techniques for concentrating motile spermatozoa in
semen (4) may remove virus associated with leukocytes and seminal plasma but
have not been shown to eliminate the virus. Moreover, HIV-1 has been reported to
attach to or enter spermatozoa (5,6), although this finding has been disputed (7,8).
HIV-1 transmission through intravaginal insemination with unprocessed donor
semen has been reported (9,10), although data regarding the magnitude of the risk
are conflicting (9-11). Whether intrauterine insemination carries a higher risk than
intravaginal procedures is not known.
The investigation reported here indicates that some HIV-1-discordant couples are
seeking methods of achieving conception without transmission of HIV infection.
However, no data exist to support the safety of any procedure purported to remove
HIV from semen. CDC recommends against insemination with semen from HIVinfected men (12).
References
1. Zagury D, Bernard J, Leibowitch J, et al. HTLV-III in cells cultured from semen of two patients
with AIDS. Science 1984;226:449-51.
2. Ho DD, Schooley RT, Rota TR, et al. HTLV-III in the semen and blood of a healthy homosexual
man. Science 1984;226:451-3.
3. Levy JA. The transmission of AIDS: the case of the infected cell. JAMA 1988;259:3037-8.
4. Berger T, Marrs RP, Moyer DL. Comparison of techniques for selection of motile spermatozoa. Fertil Steril 1985;43:268-73.
5. Miller VE, Scofield VL. Sperm mediated transfer of HIV into target cells: role in AIDS
transmission [Abstract]. V International Conference on AIDS. Montreal, Canada, June 4-9,
1989:514.

44