Effects of HIV-1 infection and antiretroviral therapy on semen parameters and sperm DNA integrity

Study question: Do HIV-1 infection and antiretroviral therapy affect semen parameters and sperm DNA integrity? Summary answer: A significant proportion of HIV-1 infected patients had semen values below the 5° percentile of the WHO 2010 reference group; sperm nuclear fragmentation rate was significantly increased in HIV-1 infected patients taking antiretroviral therapy compared with naïve HIV-1 infected patients. What is known already: HIV-1 infection may affect semen parameters, such as motility, sperm concentration, or total sperm count. HAART (highly active antiretroviral therapy) could change spermatozoa metabolism due to mitochondria damage that, in turn, may be responsible for the reduction of their motility and fertilization competence. Study design, size, duration: For the first aim of the study, we assessed the potential effects of HIV-1 infection on semen parameters and we retrospectively analyzed semen samples obtained from 770 HIV-1 patients under stable antiretroviral therapy. For the second aim of the study, we evaluated the effects of HAART on sperm DNA fragmentation and we designed a case-control prospective study, comparing semen samples of HIV-1 infected patients receiving HAART (n. 51) versus naïve HIV-1 infected patients (n. 24). For both purposes of the study patients were recruited between January 2010 and June 2015 in our Assisted Reproduction Unit in Hospital “L. Sacco” (University of Milan, Italy) and all patients were asking reproductive assistance with their HIV negative partner. Participants/materials, setting, methods: Objective 1: 770 HIV-1 patients, under stable antiretroviral therapy. Co-infections with HBV or HCV and genital tract infections represented exclusion criteria; all patients received HAART and had a CD4 count > 200 cells/mm3. Complete semen analysis was performed according to WHO 2010 recommendations, with each semen variable of the study population being compared with the WHO reference group. Objective 2: 51 HIV-1 infected patients taking antiretroviral therapy (HAART) vs. 24 HIV-1 infected patients not receiving antiretroviral therapy. Sperm DNA fragmentation and semen analysis was performed using chromatin dispersion test (SCD). For both purposes of the study, all the patients did not present any clinical sign of their disease. Main results and the role of chance: Median values of all assessed semen parameters were significantly lower in HIV-1 infected patients compared to WHO median values (p<0.05). In addition, for each semen variable, a significant proportion of HIV-1 infected patients had values below the 5° percentile of the WHO 2010 reference group (p< 0.05). Sperm DNA fragmentation rate was significantly increased in HIV-1 infected patients taking antiretroviral therapy (68.65%) compared with the group of HIV-1 infected patients not receiving antiretroviral therapy