男性人类免疫缺陷病毒（HIV）和丙型肝炎病毒（HCV）感染对血清不一致夫妇生殖结局的影响：一项病例对照研究。
Influence of male human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection on the reproductive outcomes in serodiscordant couples: a case-control study.
机构信息
Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.
Assisted Reproductive Technology Centre, Careggi Hospital, University of Florence, Florence, Italy.
出版信息
Andrology. 2019 Nov;7(6):852-858. doi: 10.1111/andr.12623. Epub 2019 Apr 16.
BACKGROUND
Nowadays, serodiscordant couples (SDCs) with human immunodeficiency virus (HIV) or hepatitis C virus (HCV)-infected men have the chance to conceive safely, giving birth with a minimum risk of cross-infection.
OBJECTIVE
To assess the impact of male HIV and HCV infection on the assisted reproductive technologies (ART) outcomes in SDCs, with HIV or HCV seropositive men and negative partners.
MATERIALS AND METHODS
Of 153 couples: 24 in Group 1 (HIV-seropositive men), 60 in Group 2 (HCV-seropositive men) and 69 in Group 3 (controls). Sperm-washing procedure was performed using a three-step system. Fresh ICSI cycles were carried out in HIV SDCs, HCV SDCs and controls. Seminal parameters, fertilization rate (FR), cleavage rate (CR), pregnancy rate per cycle (PR/C), miscarriage rate, implantation rate (IR) and live birth rate were evaluated.
RESULTS
All the seropositive men have undetectable viral loads at the time of insemination, and both partners were free from co-morbid infections. The median number of embryos transferred was 2.0 (IQR 1.0-3.0), with no differences among groups. FR was significantly reduced in HIV and HCV SDCs compared to the controls (66%, 61% and 75%, respectively; p < 0.01). CR was similar between groups (p = 0.3). IR was 12.1%, 11.1% and 14.1%, respectively, in the three groups (p = 0.30). PR/C was 21.7%, 17.6% and 20.2% in HIV, HCV and controls, respectively. Live birth rate per cycle was 17.4%, 15.7% and 15.9%, respectively. There were no significant differences in clinical pregnancies per cycle, as well as miscarriages and live births (p = 0.30; 0.30; 0.60, respectively).
CONCLUSIONS
The sperm-washing technique with ICSI may generate a promising way to improve pregnancy outcomes and to reduce the risk of viral transmission in these couples. In this setting, we can correctly counsel HIV- and HCV-infected men of SDCs with regard to the likelihood of father their own biological child.
背景
现如今，携带艾滋病毒（HIV）或丙型肝炎病毒（HCV）的血清学不一致的夫妇（SDC）有机会安全受孕，母婴传播的风险最小。
目的
评估男性 HIV 和 HCV 感染对 SDC 中辅助生殖技术（ART）结果的影响，这些 SDC 中的 HIV 或 HCV 血清阳性男性和阴性伴侣。
材料和方法
在 153 对夫妇中：24 对在第 1 组（HIV 血清阳性男性），60 对在第 2 组（HCV 血清阳性男性），69 对在第 3 组（对照组）。使用三步法进行精子洗涤程序。在 HIV SDCs、HCV SDCs 和对照组中进行新鲜的 ICSI 周期。评估精液参数、受精率（FR）、分裂率（CR）、每周期妊娠率（PR/C）、流产率、植入率（IR）和活产率。
结果
所有血清阳性男性在授精时的病毒载量均无法检测到，并且双方均无合并感染。中位数转移胚胎数为 2.0（IQR 1.0-3.0），各组之间无差异。与对照组相比，HIV 和 HCV SDCs 的 FR 明显降低（分别为 66%、61%和 75%；p<0.01）。各组之间的 CR 相似（p=0.3）。三组的 IR 分别为 12.1%、11.1%和 14.1%（p=0.30）。HIV、HCV 和对照组的每周期 PR/C 分别为 21.7%、17.6%和 20.2%。每周期活产率分别为 17.4%、15.7%和 15.9%。每周期临床妊娠率、流产率和活产率无显著差异（p=0.30；0.30；0.60）。
结论
ICSI 联合精子洗涤技术可能为改善这些夫妇的妊娠结局和降低病毒传播风险提供一种有前景的方法。在这种情况下，我们可以正确地向 SDC 中的 HIV 和 HCV 感染男性提供有关生育自己亲生子女可能性的咨询。
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