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Persistent HIV-1 RNA shedding in semen of men on HAART is associated with high risk sexual behavior
D. Anderson1, J. Politch1, W. O'Brien2, C. Xu1, F. Bowman1, K. Mayer2
1Boston University School of Medicine, Obstetrics and Gynecology, Boston, United States, 2Fenway Community Health, Fenway Institute, Boston, United States
Background: HIV-1 has been detected in semen of men on HAART with undetectable blood HIV viral load. The purpose of this study was to identify clinical and biological factors associated with seminal HIV-1 shedding in a cohort of HIV infected men on effective HAART therapy.
Methods: Subjects were 83 predominantly gay or bisexual men on stable HAART for at least 3 months with undetectable blood VL. Each man provided one paired set of blood and semen samples. Twenty-one men had consistently practiced safe sex (low-risk), and 62 had practiced unsafe sex and/or had a classic STD within the past 6 months (high-risk). Eight high-risk men had a concurrent STI/urethritis. HIV-1 RNA and DNA were measured by quantitative real-time PCR. Seminal PMNs were quantified by the Endtz method (leukocytospermia >106 PMNs/ml). HSV serostatus was assessed by Focus HerpeSelect 1 & 2 Immunoblot IgG Assay.
Results: HIV RNA was detected in 0/83 blood and 20/83 (24%) semen samples with copy numbers ranging from 80-2,560/ml. HIV proviral DNA was detected in only 2/83 semen samples. Twenty men (24%) had leukocytospermia. HIV RNA in semen was highly associated with high-risk sexual behavior (30.6% HR vs 4.8% LR, p< 0.02) and leukocytospermia (60.0% LCS vs 12.7% No LCS, p< 0.0001). There was no association between seminal HIV-1 shedding and HSV serostatus or peripheral CD4 count (p>0.10). Six of the 8 men with concurrent STI/urethritis (66%) had HIV RNA in semen.
Conclusions: In this study, 30% of HIV-infected men on effective HAART that practiced high-risk sexual behavior had HIV-1 RNA in semen. Studies are underway to determine whether their seminal HIV is infectious and bears drug resistance mutations. These results suggest that a substantial percentage of sexually active HIV-infected men on HAART can transmit HIV to sexual partners if they do not practice safe sex.
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