A decade of the sperm-washing programme: correlation between markers of HIV and seminal parameters

The aim of the study was to use a decade of experience of sperm washing to assess the effect of HIV disease on semen parameters and to highlight the continuing importance of risk reduction when some controversially advocate the safety of timed unprotected intercourse for conception in the 'stable' HIV-positive man.

Semen parameters of 439 fresh samples used for sperm washing/intrauterine insemination (IUI) were correlated against markers of HIV disease [CD4 cell count, viral load (VL), duration of HIV infection and use of antiretroviral therapy] and the risk of detectable virus in semen was assessed.

A significant positive correlation was observed between CD4 cell count and total sperm count, progressive motility, post-preparation/insemination concentration, progressive motility and total motile count inseminated (TMCI), and a significant negative correlation was observed between CD4 cell count and normal sperm morphology (Spearman's correlation; P<0.05). There was no significant difference in any parameter between samples in which VL was detectable and those in which it was undetectable. The use of highly active antiretroviral therapy (HAART) significantly decreased total sperm count, progressive motility, post-preparation count and TMCI and significantly increased proportion of abnormal forms (Mann-Whitney tests; P<0.05). There was a significant negative correlation between duration of HAART use and concentration, total sperm count and post-preparation motility and between years since diagnosis and post-preparation motility. In 9.7% of IUI cycles performed with fresh sperm in men on HAART with undetectable VL, detectable HIV was found in either pre- or post-wash seminal samples.

Our data suggest a negative effect of low CD4 cell count and the use of HAART on semen. The significant proportion of 'stable'; men with undetectable serum VL but virus in semen confirms the continued importance of such risk reduction.