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World J Virology. May 12, 2015; 4(2): 142-146
Published online May 12, 2015. doi: 10.5501/wjv.v4.i2.142
Cost and safety of assisted reproductive technologies for human immunodeficiency virus-1 discordant couples
Ming-Yih Wu, Hong-Nerng Ho
Ming-Yih Wu, Hong-Nerng Ho, Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei 10002, Taiwan
Author contributions: Wu MY and Ho HN both contributed to this paper.
Conflict-of-interest: We declare no conflicts of interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hong-Nerng Ho, MD, Department of Obstetrics and Gynecology, National Taiwan University Hospital, No. 7 Chung-Shan South Road, Taipei 10002, Taiwan. hnho@ntu.edu.tw
Telephone: +886-2-23123456 Fax: +886-2-23116056
Received: October 28, 2014
Peer-review started: October 29, 2014
First decision: December 12, 2014
Revised: December 25, 2014
Accepted: January 19, 2015
Article in press: January 19, 2015
Published online: May 12, 2015
Processing time: 183 Days and 18.1 Hours
Abstract

Due to significant advances in the treatment of human immunodeficiency virus type-1 (HIV-1), HIV-1 infection gradually has become a treatable chronic disease. Successfully treated HIV-positive individuals can have a normal life expectancy. Hence, more and more HIV-1 discordant couples in Taiwan and the rest of the world are seeking fertility assistance. Pre-treatment of highly active antiretroviral therapy (HAART) combined with sperm washing and RT-polymerase chain reaction examination for HIV-1 viral load has become the standard procedure to assist them to conceive. However, in order to reduce the transmission risk to the lowest level for the couple and to diminish the cost of health care for the insurance institutes or government, in vitro fertilization (IVF)-intracytoplasmic sperm injection (ICSI) therapy provides the ideal solution for HIV-1 discordant couples with infected men. Intrauterine insemination (IUI) theoretically introduces more than 107 times of sperm counts or semen volume to uninfected women vs IVF-ICSI. However, since some regimens of HAART may significantly decrease the sperm motility, compared to IVF-ICSI, IUI only produces 1/5 to 1/2 pregnancy rates per cycle. Given the risk of seroconversion of HIV infection which actually happens after successful treatment, IVF-ICSI for these HIV-1 seropositive men is more cost-effective and should be the first line treatment for these cases.

Keywords: Highly active antiretroviral therapy; human immunodeficiency virus-1 discordant; Seroconversion; Intrauterine insemination; Intracytoplasmic sperm injection

Core tip: For human immunodeficiency virus type-1 (HIV-1)-infected men and uninfected women, highly active antiretroviral therapy, sperm washing and HIV-1 viral load check by RT-polymerase chain reaction have become the standard procedure to enable conception. Although the risk of seroconversion of HIV infection is very low, it remains possible. Intrauterine insemination may introduce more risk of HIV-1 transmission and also possesses less chance of pregnancy compared to in vitro fertilization-intracytoplasmic sperm injection (ICSI). Therefore, ICSI may be the preferred choice.