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. 2013 Aug;57(3):441-7.
doi: 10.1093/cid/cit252. Epub 2013 Apr 17.

Shedding of HIV and human herpesviruses in the semen of effectively treated HIV-1-infected men who have sex with men

Sara Gianella  1 , Davey M Smith, Milenka V Vargas, Susan J Little, Douglas D Richman, Eric S Daar, Michael P Dube, Fan Zhang, Christina C Ginocchio, Richard H Haubrich, Sheldon R Morris; CCTG 592 Team
Affiliations

Shedding of HIV and human herpesviruses in the semen of effectively treated HIV-1-infected men who have sex with men

Sara Gianella et al. Clin Infect Dis. 2013 Aug.

Abstract

Background: Current antiretroviral therapy (ART) suppresses human immunodeficiency virus (HIV) in blood to undetectable levels in most infected individuals; however, some men shed HIV in semen despite suppressed levels in blood.

Methods: This study included 114 chronically HIV type 1-infected men who have sex with men, who were receiving ART with blood plasma HIV <500 copies/mL. Asymptomatic participants were screened for bacterial sexually transmitted infections (STIs) and nonspecific genital inflammation. Levels of HIV and 7 human herpesviruses were measured by real-time polymerase chain reaction in seminal plasma. Predictors of HIV seminal shedding were determined for the entire cohort, and on the subset of 100 subjects with blood plasma HIV <50 copies/mL.

Results: Eleven subjects (9.6%) had detectable levels of seminal HIV (median, 2.1 log10 copies/mL), and 72 (63.2%) had at least 1 herpesvirus detected in their seminal plasma. Detectable levels of seminal HIV were present more often in persons with plasma HIV between 50 and 500 copies/mL compared to those <50 copies/mL (P values adjusted for false discovery rate [FDR] = 0.08). There was a trend for high-level cytomegalovirus (CMV; >4 log10 DNA copies/mL; FDR-adjusted P = .08), and presence of Epstein-Barr virus (FDR-adjusted P = .06) in semen to be associated with detectable seminal HIV levels. In a subanalysis of 100 subjects with blood plasma HIV <50 copies/mL, high levels of CMV in semen was the only significant predictor for seminal HIV shedding.

Conclusions: Low-level HIV replication in blood and high-level seminal CMV shedding, but not presence of asymptomatic STIs, is associated with seminal shedding of HIV in men receiving ART, conferring a potential risk for HIV transmission.

Keywords: HIV shedding; HIV transmission; antiretroviral therapy; cytomegalovirus; semen.

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Figures

Figure 1.
Figure 1.
Viral frequencies in semen for each human immunodeficiency virus type 1–infected subject (N = 114). Frequency (%) of patients having at least 1 semen sample positive for any herpesvirus DNA, and for each individual tested virus separately. Note that human herpesvirus (HSV) only refers to HSV type 2, as no HSV type 1 was detected in this cohort. Abbreviations: CMV, cytomegalovirus; EBV, Epstein-Barr virus; HHV, human herpesvirus; HSV, herpes simplex virus.
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