Objective: To examine the effect of human immunodeficiency virus (HIV) infection on semen quality and to investigate the role of clinical stage of infection, mode of virus acquisition, and azidothymidine (AZT) treatment. DESIGN, PATIENTS, MAIN OUTCOME MEASURES: Ejaculates from 39 HIV-seropositive men and 51 seronegative controls were compared using conventional semen analysis parameters. Centers for Disease Control (Atlanta, GA) classification and peripheral blood CD4 lymphocyte count of seropositive men were recorded at the time of semen analysis. Five patients provided semen before and after AZT treatment.
Results: Semen from seropositive men contained significantly fewer motile sperm (48.8% versus 58.8%, P = 0.001), more round cells (62% versus 28% subjects with density greater than 1 x 10(6)/mL, P = 0.003), and was more viscous (1.3 versus 0.5 cm, P less than 0.05) than semen from seronegative controls. The proportion of motile sperm was correlated with absolute number (r = 0.49, P = 0.004) and percentage (r = 0.37, P = 0.03) of CD4-positive lymphocytes in peripheral blood. Total sperm output, however, was preserved and was not correlated with lymphocyte count or symptomatic disease. Administration of AZT had no deleterious effect on sperm output or other semen variables.
Conclusion: Human immunodeficiency virus infection per se does not significantly reduce sperm production, regardless of clinical stage or mode of acquisition; however, HIV-seropositive men produce more viscous semen containing fewer motile sperm and more round cells.