HIV transmission through donor artificial insemination

Abstract

Objective: To investigate and report cases of human immunodeficiency virus (HIV) transmission through donor artificial insemination (AI) before 1986 at five infertility clinics.

Design: Two types of look-back studies were performed: (1) identification of an HIV-infected woman who reported previous AI, followed by identification of the infected donor(s) and contact tracing of women who were inseminated with his semen, and (2) identification of an HIV-infected donor and subsequent examination of women receiving AI procedures using his semen.

Setting: Five infertility clinics in Los Angeles County, California; San Diego County, California; Arizona; and Vancouver, British Columbia.

Patients: A total of 230 women were inseminated with semen from any one of the five identified HIV-infected donors; 199 (87%) consented to HIV testing.

Main outcome measure: Seropositivity for HIV among AI recipients.

Results: Seven (3.52%) of the 199 women (95% confidence interval, 1.55% to 7.41%) who were artificially inseminated with semen from any of five HIV-infected donors and consented to HIV testing tested HIV-seropositive. Information on HIV risk was available for three of the five donors; all three reported a history of having sex with men. Four HIV-infected women were identified through uncommon circumstances, rather than through routine look-back studies of donors.

Conclusion: Infection with HIV through donor AI performed before routine HIV screening of semen donors represents a potentially serious threat to women who underwent AI procedures. Public health policies requiring retrospective identification of HIV-infected semen donors and patients receiving AI before 1986, especially in acquired immunodeficiency syndrome (AIDS)-prevalent areas, should be considered routine. Women diagnosed with AIDS or HIV infection, in whom no identified risk of HIV acquisition is established, should be questioned about previous AI procedures.