Note: The authors submitted this letter in late June 1995. In November we learnt that Professor Stewart was not going to reply. Instead, he was planning to publish a follow-up elswhere. We made several unsuccessful attempts to contact Professor Stewart and informed the editor of Lancet of our failure to do so. A reply from Stewart and Downie was published by Lancet (Vol. 347: page 970 April 6th, 1996). Our reply to their reply was rejected by Lancet.

HIV TRANSMISSION BY DONOR SEMEN

SIR -- In September 1985, in the Journal, seven Sydney researchers claimed "convincing evidence for transmission of HTLV-III [HIV]" to four women following in vitro fertilisation using semen donated by a bisexual man.(1) This report still remains the only evidence for HIV transmission by such means and is also considered one of the most important pieces of evidence proving the infectivity of semen. The evidence for transmission of HIV was based on Western blot testing where each individual had the following bands: donor-p24/gp41; first woman-gp41; second woman-p24/gp41; third woman-p24/gp41; fourth woman-p24. However, the present Australian criteria for a positive Western blot are "reactivity to at least one glycoprotein (gp41-5, gp110-120, or gp160) and three other viral proteins of gag (p12, p18, p24, p40, p55) or pol (p34, p53, p68) origin. A negative WB had to show no reactivity to viral proteins; reactivity to viral proteins that did not fulfil positive or negative criteria was considered indeterminate".(2) Thus, by the present criteria for a positive Western blot in Australia none of the four women or even the donor would be considered HIV positive. Neither would any be positive under the criteria set by the FDA and the American Red Cross. In fact, two of the women would not be positive by any criteria anywhere in the world.(3) According to Anthony Fauci, "the least likely explanation for an indeterminate western blot is that the individual is infected with HIV", and "The most likely explanation is that the patient being tested has antibodies that cross react with one of the proteins of HIV. The most common patterns of reactivity are antibodies that react with p24 and/or p55".(4) Thus the above data poses the following questions: (i) have these five individuals been retested and if so, have they all been found positive and by what criteria? (ii) if some or all were not found positive have the authors modified or retracted their claims? (iii) if not retested, why not and are they still considered to be infected with HIV? (iv) have any of these individuals been treated for HIV/AIDS and if so, with what drugs and on the basis of what tests?

Eleni Papadopulos-Eleopulos (1) Valendar F.Turner (2) John M. Papadimitriou (3) David Causer (1)

(1) Department of Medical Physics, (2) Department of Emergency Medicine, Royal Perth Hospital, Perth, Western Australia; (3) Department of Pathology, University of Western Australia.

References

1. Stewart GJ, Cunningham AL, Driscoll GL, et al. Transmission of human T-cell lymphotropic virus the III (HTLV-III) by artificial insemination by donor. Lancet; ii: 581-584.

2. Healey DS, Maskill WJ, Howard TS, et al. HIV-1 Western blot: development and assessment of testing to resolve indeterminate reactivity. AIDS 1992; 6: 629-633.

3. Papadopulos-Eleopulos E, Turner VF, Papadimitriou JM. Is a Positive Western Blot Proof of HIV Infection? Bio/Technology 1993; 11: 696-707.

4. Fauci AS, Lane HC. Human Immunodeficiency Virus (HIV) Disease: AIDS and Related Disorders. In Harrison's Principles of Internal Medicine 13th edn., ed. Isselbacher, K.J., Braunwald, E., Wilson, J.D., Martin, J.B., Fauci, A.S., Kasper, D.L. pp. 1566-1618. 1994. New York: McGraw-Hill Inc.