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March 15, 1995

HIV Transmission Through Donor Artificial Insemination

Author Affiliations

From the Los Angeles (Calif) County Department of Health Services (Drs Araneta and Mascola and Mss Eller and O'Neil); San Diego (Calif) County Department of Health Services (Dr Ginsberg and Mr Bursaw); and British Columbia Centre for Disease Control, Vancouver (Dr Rekart). Dr Araneta is now with the Naval Health Research Center, San Diego, Calif. Ms O'Neil is now with the University of Southern California, Los Angeles. Drs Marik, Friedman, and Sims are in private practice in Los Angeles, Calif. Dr Collie is in private practice in San Luis Obispo, Calif.

JAMA. 1995;273(11):854-858. doi:10.1001/jama.1995.03520350036025

Objective.  —To investigate and report cases of human immunodeficiency virus (HIV) transmission through donor artificial insemination (Al) 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 Al, 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 Al 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 Al performed before routine HIV screening of semen donors represents a potentially serious threat to women who underwent Al procedures. Public health policies requiring retrospective identification of HIV-infected semen donors and patients receiving Al 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 Al procedures.(JAMA. 1995;273:854-858)