HICN 314 News -- excerpts.
David Canzi
Medical News for Week Ending April 22, 1990
Copyright 1990: USA TODAY/Gannett National Information Network
Reproduced with Permission
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April 17, 1990
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AIDS AND ETHICS CONFERENCE:
The first annual "AIDS & Ethics" conference will be held in San Francisco,
at the Marriott Hotel, June 24-27. Speakers from the United States, Europe,
and Australia will present the most current thinking on immigration
regulations; protecting children with AIDS; issues in the Hispanic and Black
communities; needle exchange; access to untested therapies; and HIV education.
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April 18, 1990
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AIDS NOT SO RARE IN TEENS:
The AIDS virus may not be as rare as once thought. About one-in- 3,000 U.S.
teenagers applying for military service between 1985 and 1989 tested positive
for the AIDS virus. The Journal of the American Medical Association says
doctors found 393 infections among one million applicants under age 20.
Infection was more common in blacks than Hispanics and whites.
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April 19, 1990
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AIDS MAY SKYROCKET IN RUSSIA:
Shortages of medical supplies may cause an apocalyptic AIDS epidemic
infecting 20 million Soviets by the year 2000, reports OGONYOK, a popular
weekly Soviet magazine. These predictions underscore the crisis of the
country's shocking medical inefficiencies: Most victims get AIDS in hospitals.
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Center for Disease Control Reports
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Morbidity and Mortality Weekly Report
Thursday April 19, 1990
Epidemiologic Notes and Reports
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((R))**) 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, sero negative 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 (Continued on page 255)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 trans mission; 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 HIV-infected 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.
6. Bagasra O, Freund M, Weidmann J, Harley G. Interaction of human
immunodeficiency virus with human sperm in vitro. J AIDS 1988;1:431-5.
7. Pudney J. Caveats associated with identifying HIV using transmission
electron microscopy. In: Alexander NJ, Gabelnick HL, Spieler JM, eds.
Heterosexual transmission of AIDS: proceedings of the Second Contraceptive
Research and Development (CONRAD) Program International Workshop. New York:
Wiley-Liss, 1989:197-204.
8. Anderson D, Wolff H, Wenhao Z, Pudney J, Dorfman T, Mayer K. Evidence
against HIV-1 attachment to human spermatozoa. Science (in press).
9. Stewart GJ, Tyler JPP, Cunningham AL, et al. Transmission of human T-cell
lymphotropic virus type III (HTLV-III) by artificial insemination by donor.
Lancet 1985;2:581-4.
10. Chiasson MA, Stoneburner RL, Joseph SC. Human immunodeficiency virus
transmission though artificial insemination. J AIDS 1990;3:69-72.
11. Eskenazi B, Pies C, Newstetter A, Shepard C, Pearson K. HIV serology in
artificially inseminated lesbians. J AIDS 1989;2:187-93.
12. CDC. Semen banking, organ and tissue transplantation, and HIV antibody
testing. MMWR 1988;37:57-8,63.
*4-(2-Hydroxyethyl)piperazineethanesulfonic acid.
**Use 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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Volume 3, Number 14 April 23, 1990
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Editor: David Dodell, D.M.D.
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David Canzi