Antiretrovirals and fertility – implications for couples looking to conceive

Simon Collins, HIV i-Base

A study looking at mitochondrial toxicity in sperm, also presented data on the effect of several HIV treatments on sperm quality in an HIV positive man before and after starting combination therapy.

Multiple semen samples were taken prior to initiating HAART and then regularly at six monthly intervals. Sperm count and motility were analysed together with semen plasma viral load (NASBA nuclisens).

Sperm count dropped from 106 million/ml pre-treatment to 0.3 million/ml after 12 weeks on d4T, ddI, nevirapine and hydroxyurea. Six months after a second treatment change, dropping hydroxyurea switching ddI/d4T to ZDV/3TC sperm count had risen to 21 million/ml.

Similar dramatic changes were found in sperm motility.

Table 1

Pre-therapy 12 wks Rx (ddi/d4T/NVP/HU) 24 wks Rx (ZDV/3TC/NVP)
SPVL (c/ml) 12,000 BLQ NA
Sperm count 106 x 10 6 0.3 x 10 6 21 x 10 6
Semen quality
Rapid 57% 0% 7%
Medium 17% 1% 23%
Slow 7% 7% 6%
Static 19% 92% 64%

Hydroxyurea was believed to be responsible for the major changes in sperm count and motility in this study, and although this is only a single case study, the effect on fertility of different combinations is clearly important for couples looking to have children.

This is an option many HIV positive people are now able to consider (there are ‘sperm-washing’ clinics in both London and Birmingham for discordant couples) and who may want to adjust their treatment for a period with this aspect in mind.


  1. Mital D, St John J, White D et al – Can semen quality and mitochondrial DNA deletions be used as a marker of nucleoside analogue toxicity? XIII International AIDS Conference, Durban, July 9-14, 2000. Abstract MoPeA2122.

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