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. 2012 Jul 31;26(12):1535-43.
doi: 10.1097/QAD.0b013e328353b11b.

Highly active antiretroviral therapy does not completely suppress HIV in semen of sexually active HIV-infected men who have sex with men

Joseph A Politch  1 , Kenneth H Mayer, Seth L Welles, William X O'Brien, Chong Xu, Frederick P Bowman, Deborah J Anderson
Affiliations

Highly active antiretroviral therapy does not completely suppress HIV in semen of sexually active HIV-infected men who have sex with men

Joseph A Politch et al. AIDS. .

Abstract

Objective: Although HAART can suppress genital shedding and sexual transmission of HIV, men who have sex with men (MSM) have experienced a resurgent HIV epidemic in the HAART era. Many HIV-infected MSM continue to engage in unsafe sex, and sexually transmitted infections (STIs) or other factors may promote genital HIV shedding and transmission in this population despite HAART. In this study, we determined the prevalence of seminal HIV shedding in HIV-infected MSM on stable HAART, and its relationship with a number of clinical, behavioral and biological variables.

Design: Sexually active HIV-infected men using HAART were recruited from an MSM health clinic to provide semen and blood samples.

Methods: HIV levels were assessed in paired semen and blood samples by PCR. Clinical and behavioral data were obtained from medical records and questionnaires. Herpes simplex virus 2 (HSV-2) serostatus, seminal HSV-2 DNA, and markers of genital inflammation were measured using standard laboratory methods.

Results: Overall, HIV-1 was detected in 18 of 101 (18%) blood and 30 of 101 (30%) semen samples. Of 83 men with undetectable HIV in blood plasma, 25% had HIV in semen with copy numbers ranging from 80 to 2560. Multivariate analysis identified STI/urethritis (P = 0.003), tumor necrosis factor α (P = 0.0003), and unprotected insertive anal sex with an HIV-infected partner (P = 0.007) as independent predictors of seminal HIV detection.

Conclusion: STIs and genital inflammation can partially override the suppressive effect of HAART on seminal HIV shedding in sexually active HIV-infected MSM. Low seminal HIV titers could potentially pose a transmission risk in MSM, who are highly susceptible to HIV infection.

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Conflict of interest statement

The authors have no conflicts of interest.

Figures

Figure 1
Figure 1
Cell-free and cell-associated HIV RNA and DNA in semen of men with detectable (BP-HIV+) and undetectable (BP-HIV−) HIV in blood plasma. Cell-Free HIV is expressed as HIV-1 copies per ml seminal plasma. Cell-associated HIV RNA and DNA are numbers of copies per sample. The dotted line indicates the lower limit of HIV detection, and values under this line represent samples with “undetectable” HIV. BP-HIV+ men had significantly higher concentrations of cell-free HIV RNA (mean ± SE: 4,438 ± 3,388 vs. 51 ± 17, p< 0.03), cell-associated HIV RNA (1,604 ± 1,006 vs. 50 + 31, p<0.005) and cell-associated HIV DNA (41 ± 26 vs. 5 ± 4, p< 0.009).
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