Efficacy and safety of intrauterine insemination and assisted reproductive technology in populations serodiscordant for human immunodeficiency virus: a systematic review and meta-analysis

Arti Barnes; Daniel Riche; Leandro Mena; Thérèse Sison; Lauren Barry; Raveena Reddy; James Shwayder; John Preston Parry

doi:10.1016/j.fertnstert.2014.05.001

Efficacy and safety of intrauterine insemination and assisted reproductive technology in populations serodiscordant for human immunodeficiency virus: a systematic review and meta-analysis

Fertil Steril. 2014 Aug;102(2):424-34. doi: 10.1016/j.fertnstert.2014.05.001. Epub 2014 Jun 18.

Authors

Arti Barnes¹, Daniel Riche², Leandro Mena¹, Thérèse Sison³, Lauren Barry⁴, Raveena Reddy⁵, James Shwayder⁴, John Preston Parry⁶

Affiliations

¹ Division of Infectious Diseases, Department of Medicine, University of Texas, Southwestern, Dallas, Texas.
² Department of Pharmacy Practice, University of Mississippi Medical Center, Jackson, Mississippi.
³ University of Mississippi Medical School, Jackson, Mississippi.
⁴ Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, Mississippi.
⁵ Department of Pathology, University of Mississippi Medical Center, Jackson, Mississippi.
⁶ Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Mississippi Medical Center, University of Mississippi, Jackson, Mississippi. Electronic address: fertility@umc.edu.

PMID: 24951364
DOI: 10.1016/j.fertnstert.2014.05.001

Abstract

Objective: To assess procreative outcomes for HIV-positive men and women with seronegative partners.

Design: Systematic review and meta-analysis.

Setting: Not applicable.

Patient(s): Twenty-four studies with extractable data for HIV-serodiscordant couples undergoing intrauterine insemination (IUI) or in vitro fertilization (IVF).

Intervention(s): None.

Primary outcomes: HIV transmission to a seronegative partner and per cycle fecundability; secondary outcomes: analysis of multiple gestation rates, miscarriage rates, and cancellation rates.

Result(s): For serodiscordant couples, HIV-positive men or women undergoing IUI and IVF treatment had a 17%, 30%, 14%, and 16% per cycle fecundability, respectively. Multiple gestation rates were 10%, 33%, 14%, and 29%, respectively. Miscarriage rates were 19%, 25%, 13%, and 20%, respectively. No HIV transmission was observed in 8,212 IUI and 1,254 IVF cycles, resulting in 95% confidence that the true rate is 4.5 transmissions per 10,000 IUI cycles or less.

Conclusion(s): In serodiscordant couples, IUI and IVF seem effective and safe based on the literature. Evidence-based practice and social justice suggest that our field should increase access to care for HIV-serodiscordant couples.

Keywords: HIV; IUI; IVF; insemination; serodiscordant.

Published by Elsevier Inc.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Antiretroviral Therapy, Highly Active
Female
Fertility
HIV Infections / blood
HIV Infections / diagnosis
HIV Infections / drug therapy
HIV Infections / transmission*
HIV Long-Term Survivors*
HIV Seronegativity*
HIV Seropositivity*
Health Services Accessibility*
Healthcare Disparities
Humans
Insemination, Artificial, Homologous* / adverse effects
Male
Patient Safety
Pregnancy
Pregnancy Complications / etiology
Reproductive Techniques, Assisted* / adverse effects
Risk Assessment
Risk Factors
Spouses*
Treatment Outcome