HIV This Week

van Leeuwen E, Wit FW, Repping S, Eeftinck Schattenkerk JK, Reiss P, van der Veen F, Prins JM. Effects of antiretroviral therapy on semen quality. AIDS. 2008; 22(5):637-42.

Van Leeuwen and colleagues aimed to evaluate the effect of combination antiretroviral therapy on semen quality in a longitudinal cohort study from the HIV outpatient clinic of the Academic Medical Centre in Amsterdam, the Netherlands. A cohort of 34 male patients with different estimated duration of HIV-1 infection, who were about to start various combinations of combination antiretroviral therapy, were included. Blood and semen were analyzed before the start of combination antiretroviral therapy and 4, 12, 24, 36 and 48 weeks thereafter. The authors examined the effect of combination antiretroviral therapy on semen parameters by a repeated measurements procedure using a mixed-effects model. The median period of follow up was 48 weeks (interquartile range 33-52 weeks). Five patients used thymidine analogue-containing combination antiretroviral therapy, 23 used tenofovir-based combination antiretroviral therapy, six used other regimens. At all timepoints the percentage of progressively motile spermatozoa was low according to WHO criteria, and it decreased significantly from 28 to 17% during follow-up (P = 0.02). All other semen parameters were in the normal range and remained stable. In conclusion, combination antiretroviral therapy negatively affected the percentage of progressively motile spermatozoa. Whether this reduced motility affects the chances of fathering a child or leads to an increased need for artificial reproductive techniques is at present unknown.

Editors’ note: This longitudinal study was short in duration but had the advantage that each man starting on antiretroviral treatment served as his own before/after control. All semen parameters remained normal with the exception of reduced spermatozoa motility. This may be mediated by mitochondrial dysfunction causing mitochondrial depletion or by some other mechanism linked to one or more drug classes. Whether this effect persists over time and whether it has an effect on fertility remain unknown and deserve more study.