Sperm washing for HIV serodiscordant couples using double density gradient with swim up for intrauterine insemination: defining favorable male and female factors for achieving successful pregnancy

Abstract Background: Urocortin is a neuropeptide produced by the human endometrium and has biological effects putatively important for promoting blastocyst implantation. We measured urocortin concentrations in samples of endometrial wash fluid collected from women with unexplained infertility who underwent intrauterine insemination (IUI). Methods: Patients 28–42 years of age (n = 71) were consecutively enrolled after a complete clinical evaluation. Endometrial wash fluid was retrieved before IUI, at the time of ultrasound evaluation of endometrial thickness. Urocortin concentrations were assayed with a specific ELISA. Results: After IUI, 28 patients (39%) became pregnant. Urocortin concentrations were significantly higher in women who became pregnant than in those who did not (0.38 μg/L vs 0.13 μg/L, P <0.0001). At a cutoff of 0.321 μg/L, urocortin results were positive in 61% [95% confidence interval (CI), 41%–78%] of women who had successful implantation and negative in 98% (95% CI, 88%–99.6%) of those who did not. The pregnancy rate for women with urocortin concentrations >0.32 μg/L was 94%, which differed significantly (P <0.05) from the overall pregnancy rate of 39% in the study population. Conclusions: Urocortin is measurable in endometrial wash fluid, and its concentrations before IUI are higher in women who subsequently achieve pregnancy. These data suggest that the probability of having a successful pregnancy-producing IUI may be better estimated by measuring urocortin in endometrial wash fluid.

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Couple-Focused Interventions for HIV-Serodiscordant Couples During Transition to Motherhood

Contemporary Family Therapy ◽

10.1007/s10591-011-9152-8 ◽

2011 ◽

Vol 33 (2) ◽

pp. 143-160 ◽

Cited By ~ 10

Author(s):

Marco Pereira ◽

Frank M. Dattilio ◽

Maria Cristina Canavarro ◽

Isabel Narciso

Keyword(s):

Serodiscordant Couples ◽

Transition To Motherhood ◽

Hiv Serodiscordant Couples

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Pre-exposure prophylaxis for HIV-negative persons with partners living with HIV: uptake, use, and effectiveness in an open-label demonstration project in East Africa

Gates Open Research ◽

10.12688/gatesopenres.12752.2 ◽

2018 ◽

Vol 1 ◽

pp. 3 ◽

Cited By ~ 7

Author(s):

Renee Heffron ◽

Kenneth Ngure ◽

Josephine Odoyo ◽

Nulu Bulya ◽

Edna Tindimwebwa ◽

...

Keyword(s):

Hiv Infections ◽

Hiv Treatment ◽

Demonstration Project ◽

Hiv Incidence ◽

Serodiscordant Couples ◽

Treatment Services ◽

Hiv Serodiscordant Couples ◽

Exposure Prophylaxis ◽

Living With Hiv ◽

Hiv Negative

Background: Pre-exposure prophylaxis (PrEP) can provide high protection against HIV infection and is a recommended intervention for HIV-negative persons with substantial HIV risk. Demonstration projects conducted in diverse settings worldwide illustrate practical examples of how PrEP can be delivered. This manuscript presents estimates of effectiveness and patterns of PrEP use within a two-year demonstration project of PrEP for HIV-negative members of heterosexual HIV serodiscordant couples in East Africa. Methods: The PrEP delivery model integrated PrEP into HIV treatment services, prioritizing PrEP use for HIV-negative partners within serodiscordant couples before and during the first 6 months after the partner living with HIV initiated antiretroviral therapy (ART). We measured PrEP uptake through pharmacy records and adherence to PrEP through medication event monitoring system (MEMS) bottle caps and quantification of tenofovir in plasma among a random sample of participants. We estimated HIV infections prevented using a counterfactual cohort simulated from the placebo arm of a previous PrEP clinical trial. Results: We enrolled 1,010 HIV serodiscordant couples that were naïve to ART and PrEP. Ninety-seven percent of HIV-negative partners initiated PrEP. Objective measures suggest high adherence: 71% of HIV-negative participants took ≥80% of expected doses, as recorded via MEMS, and 81% of plasma samples had tenofovir detected. Four incident HIV infections were observed (incidence rate=0.24 per 100 person-years), a 95% reduction (95% CI 86-98%, p<0.0001) in HIV incidence, relative to estimated HIV incidence for the population in the absence of PrEP integrated into HIV treatment services. Conclusions: PrEP uptake and adherence were high and incident HIV was rare in this PrEP demonstration project for African HIV-negative individuals whose partners were known to be living with HIV. Delivery of PrEP to HIV-negative partners within HIV serodiscordant couples was feasible and should be prioritized for wide-scale implementation.

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